Should a feasibility study of proactive community pharmacy take home naloxone supply vs. usual care be undertaken?

Jenny Scott, University of Bath

In 2017 I was part of a team led by Prof Sir John Strang (KCL) that was shortlisted for NIHR funding. Our application aimed to evaluate the provision of take home naloxone from several community settings. We have since reflected and in collaboration with Prof Strang, I would like to take forward the community pharmacy aspect of the previous application. However, I have some research skills gaps that I need to fill first. This application is concerned with these gaps.  

The topic of my research is preventing deaths related to illicit opiates. There is concern about escalating opiate related deaths in the UK being at an all-time high (ONS, 2017). A multi-pronged approach is needed. One of the prongs is the wider provision of take home naloxone (THN). Since 2015 in the UK it has been legal to provide naloxone without prescription ‘for the purpose of saving a life’.  Community pharmacies, as one of several outlets, could widen the distribution net. Pharmacies are easily accessible on a ‘drop-in’ basis.  It seems logical for any local THN scheme to include them. However introduction has been patchy, there is a lack of evidence to support involvement and the viability, suitability and impact of community pharmacy THN remains unknown. Our long-term goal is to undertake a cluster randomised controlled trial comparing proactive community pharmacy take home naloxone (PCPTHN) with usual care (and other outlets). However before this can be done, there are several steps in the complex intervention evaluation process that need to be undertakenThis application relates to the start of this journey  prior to any feasibility study. 

My initial question is: Should a feasibility study of proactive community pharmacy take home naloxone supply vs. usual care be undertaken? 

propose qualitative interviews with pharmacists to explore their views on naloxone supply and trial design. Needle and syringe programme (NSP) pharmacy supply of THN will start in Wiltshire summer 2018. I will conduct interviews with pharmacists (n=10) after they begin supply to explore preliminary experiences and factors they feel are important in supply– operational, educational and support, for example. I will also interview NSP pharmacists (n=10) in an area not supplying naloxone (Somerset) to explore their views as a non supplier.  

I will also explore the possibility of undertaking a feasibility study of PCPTHN vs. usual care. In particular I will seek views on the practicalities of data collection and what this design might look like, establishing how pharmacists feel about proactively offering naloxone; how acceptable it is to them to be in a trial and what the design would need to take into account in order for them to be able to collect data; what data they could (and could not) collect; what would be the best way to record it; and what the financial cost of the research might be? 

Once I have completed my proposed training and research, I expect to be able to confirm if a feasibility study is viable. If yes, I can then design it and an accompanying process evaluation. I will also have the knowledge and skills needed to design any future randomised cluster trial.

This project ran from January 2018 to December 2019. The final report is available to view here.