Presentation (CTI)

OBJECTIVES: Naloxone is an evidence-based medication for reversing opioid-related overdoses. Policy initiatives, including statewide naloxone standing orders and approval of over-the-counter (OTC) naloxone, have expanded pharmacy-based access. In rural areas, community pharmacies often serve as the primary access point; however, evidence describing naloxone availability, dispensing practices, and stakeholder perspectives in rural pharmacy settings remains limited. This systematic review aims to synthesize existing evidence on rural pharmacy-based naloxone access by characterizing: (a) naloxone stocking and dispensing patterns, (b) pharmacists’ knowledge, attitudes, and practices related to naloxone provision, and (c) patient and community perspectives on accessing naloxone in rural settings.
METHODS: A systematic literature search was conducted in PubMed, CINAHL, and Web of Science. A total of 155 citations were identified. After removal of 68 duplicates, 87 titles and abstracts were screened, and 41 articles underwent full-text review. Thirty-nine peer-reviewed studies met the inclusion criteria. This review followed PRISMA guidelines.
RESULTS: Included studies comprised cross-sectional surveys, secret shopper audits, qualitative interviews, mixed-methods evaluations, and program implementation studies. Naloxone stocking and dispensing varied substantially across rural pharmacies, with reported availability ranging from 38.3% to 100%. Naloxone availability was lower in independent pharmacies than in chain pharmacies. Common pharmacist-reported barriers included high costs, reimbursement challenges, workflow constraints, limited training, and uncertainty regarding legal dispensing pathways. Several studies also reported low perceived need among patients, including beliefs that naloxone was unnecessary or that overdose risk was unlikely. Reported facilitators of increased provision included pharmacist training, standardized protocols, workflow integration, reduced patient cost, and increased product visibility following OTC availability.
CONCLUSIONS: Rural pharmacy-based naloxone access remains uneven. Addressing cost-related barriers, training gaps, workflow constraints, legal clarity, and low perceived need among patients may strengthen pharmacy-based naloxone distribution in rural communities.