Examining the effects of COVID-19 on pharmacy dispensing of naloxone and syringes sales across Massachusetts and New Hampshire.

BACKGROUND: Coronavirus disease 2019 (COVID-19) lockdowns disrupted access to harm reduction supplies and services known to be effective in overdose prevention and contributed to a worsening of the opioid crisis. However, because pharmacies can provide naloxone and sell over-the-counter (OTC) sterile syringes, their continued operation throughout the pandemic potentially reinforced a public health role as a distribution hub for safer use supplies. OBJECTIVES: The objective of this analysis was to examine patterns of naloxone and OTC syringe sale volume at 463 community pharmacies in 2 states with high overdose rates during the COVID-19 pandemic. METHODS: We analyzed weekly pharmacy-level dispensing data from January 5, 2020, to December 31, 2020, from one corporate community pharmacy chain in Massachusetts (n = 415 pharmacies) and New Hampshire (n = 48 pharmacies). Descriptive statistics and visualizations over the analytical period were generated as initial explorations of the outcome. Zero-inflated Poisson and negative binomial models were used to analyze distribution data along with county-level COVID-19 case rates and store-level COVID-19 testing location status during the same time. Interactions tested the effect of COVID-19 case rates on naloxone and OTC syringe sales. RESULTS: Pharmacies that reported selling nonprescription syringes and dispensing naloxone during the study period averaged 210.13 OTC syringes sold and 0.53 naloxone prescriptions per week. Pharmacies in communities that experienced greater COVID-19 case burden also exhibited higher naloxone dispensing and OTC syringe sales during this period. The odds of selling OTC syringes increased over time but naloxone dispensing remained constant over the pandemic year. Pharmacies hosting COVID-19 testing tended to have lower OTC syringe sales and naloxone provision than nontesting sites. CONCLUSION: During the COVID-19 pandemic, pharmacies provided harm reduction services and dispensed lifesaving medications by quickly adapting to fulfill community needs without disrupting co-located services for COVID-19 response.

Federal Policymakers Should Urgently and Greatly Expand Naloxone Access

Since March 2020, the US federal government has invested tremendous public health effort in COVID-19 responses by expediting the availability of vaccines and have therapeutics. Reduced access to addiction treatment and services combined with fentanyl infiltrating drug supplies resulted in an estimated 100000 fatal overdoses in 2020 alone.1 Although the Centers for Disease Control and Prevention iCDC;has released official health advisories2 and the US Department of Health and Human Services (HHS) has supported widespread implementation of expanded distribution and use of naloxone in high-risk populations, there is not enou ugh naloxone in the hands of those who need it most. The opioid overdose crisis continues to ravage communities;thus, we call for federal policymakers within the US Department of Health and Human Services or the FDA to facilitate OTC approval of at least one formulation of naloxone, with or without manufacturer request or approval. State legislatures that implemented coprescribing mandates have seen substantial increases in naloxone prescribing, engagement of a larger and more diverse set of prescribers, expanded geographic reach, and reductions in opioid-related harm.18-20 In 2018, a panel of experts at the Drug Safety and Risk Management Advisory Committee narrowly voted against a coprescribing mandate, citing concerns for potential risks of drug shortages, diverting naloxone from community programs, rise in health care costs, institutional racism benefiting insured patients, and threats to provider autonomy in identifying patient risk.21 Instead, this committee recommended changing opioid prescription labels to encourage coprescription, which was released as an FDA mandate in July 2020 to opioid drug manufacturers.22 Although it remains unclear if these label changes were widely implemented, they serve as a mere nudge for providers to have discussions with their patients about the importance of naloxone, whereas mandatory coprescribing will facilitate increased distribution ofthis lifesaving medication.

COVID-19 and influenza vaccine hesitancy among college students.

BACKGROUND: Successful vaccination against coronavirus disease 2019 (COVID-19) is an essential component of achieving community immunity to bring the COVID-19 pandemic to an end. Vaccine hesitancy, identified as a top threat to global health by the World Health Organization, is a significant barrier to vaccine uptake. With COVID-19 vaccination programs in effect since December 2020, it is critical that vaccination barriers are proactively identified. With limited information surrounding college students' perspectives on COVID-19 vaccines, outreach measures will play a pivotal role in vaccine uptake in this population. Development of informative, cohort-driven vaccination campaigns requires proactive assessment of factors influencing vaccine hesitancy, access, and uptake. OBJECTIVES: The primary objective of this study was to investigate the spectrum of vaccine hesitancy among college students at the University of Rhode Island (URI). The secondary objective was to identify differences in COVID-19 and influenza vaccine hesitancy rates in this population. METHODS: A 22-item, Institutional Review Board-approved, anonymous questionnaire was developed to survey URI students who voluntarily attended 2 joint University Health Services and College of Pharmacy influenza vaccination clinics in November 2020. RESULTS: A total of 237 vaccination clinic participants consented and responded to at least 1 question on the survey. Once available to their respective priority group, 92% are very/somewhat likely to receive a COVID-19 vaccine and 50% will receive a COVID-19 vaccine as soon as possible. Only 3% of the participants stated that they would never receive a COVID-19 vaccine. The top 3 reported COVID-19 vaccine-related concerns were safety (37%), effectiveness (24%), and limited information (16%). When asked if COVID-19 vaccines and influenza vaccines should be mandated, 85% and 83%, respectively, were in favor. CONCLUSION: Understanding the spectrum of vaccine hesitancy is critical in achieving COVID-19 community immunity thresholds. URI students are willing to be vaccinated against COVID-19 provided that the vaccines are proven safe and efficacious.

Pharmacists' response during a pandemic: A survey on readiness to test during COVID-19.

BACKGROUND: Testing is a principle component to reopening society and bringing the coronavirus 2019 (COVID-19) pandemic to an end. Pharmacists have the ability to perform certain point-of-care tests under federal regulations. On April 8, 2020, the Office of the Assistant Secretary for Health issued new guidance authorizing licensed pharmacists to order and administer COVID-19 tests. OBJECTIVE: The primary objective of this study was to investigate the views of pharmacists about pharmacist-ordered and -administered COVID-19 testing. METHODS: A 13-item questionnaire was developed to survey pharmacists who currently hold an active license in Rhode Island. RESULTS: A total of 122 (13.8%) pharmacists consented and responded to at least 1 question of the survey. The results indicated that the primary concern of the pharmacists in regard to performing COVID-19 testing was spreading the infection to family members (71.3%). Becoming personally infected (59.8%) and not having access to appropriate personal protective equipment (PPE) (62.3%) were the second and third most common concerns of the pharmacists. Almost all of the pharmacists (99.9%) responded that they would be willing to take part in the testing process if they had appropriate PPE. A total of 46% of the pharmacists expressed concern regarding reimbursement for their company, whereas 56% of the pharmacists requested personal compensation for this service. CONCLUSION: Expanding the pool of health care providers who can perform testing is critical to achieving and sustaining proposed testing thresholds. Rhode Island pharmacists are willing to take part in performing COVID-19 testing provided appropriate PPE is available and services are reimbursed. Pharmacists are the most accessible and essential health care providers willing to take on critically important roles during the COVID-19 pandemic provided appropriate safety measures can be met.

Community Pharmacists' Contributions to Disease Management During the COVID-19 Pandemic.

Community pharmacists assist patients to manage disease and prevent complications. Despite the enormous challenge the coronavirus disease 2019 (COVID-19) pandemic has dealt to the health care system, community pharmacists have maintained the delivery of critical health services to communities, including those most at risk for COVID-19. Community pharmacists are in a key position to deliver priority pandemic responses including point-of-care testing for chronic disease management, vaccinations, and COVID-19 testing.

Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment.

We highlight the critical roles that pharmacists have related to sustaining and advancing the changes being made in the face of the current COVID-19 pandemic to ensure that patients have more seamless and less complex access to treatment. Discussed herein is how the current COVID-19 pandemic is impacting persons with substance use disorders, barriers that persist, and the opportunities that arise as regulations around treatments for this population are eased.