Implementation of Medication Disposal Programs and Availability of Same-Day Naloxone at Community Pharmacies: Protocol for a Secret Shopper Caller Approach

Abstract

Background: Pharmacies can implement multiple strategies, including medication disposal programs (eg, disposal boxes, deactivation products, and mail-back envelopes) and offering over-the-counter naloxone, to prevent nonmedical opioid use and overdose. The quantity of opioid prescriptions dispensed in the United States is so high that every other adult could receive one opioid prescription per year. Many of these opioids go unused and are kept in homes rather than disposed of after ceasing use. The primary source of prescription opioids for nonmedical use is relatives or friends, which suggests that the diversion of excess and retained prescription opioids contributes significantly to nonmedical use. Naloxone is a life-saving medication that works as an opioid antagonist to reverse the effects of opioids and restore normal breathing to a person experiencing an overdose. All 50 US states have passed laws (eg, statewide standing orders) that allow pharmacists to distribute naloxone without an individual patient prescription, and the US Food and Drug Administration approved the first over-the-counter naloxone medication in March 2023. Individual and neighborhood characteristics are associated with nonmedical opioid use and overdose. It is essential to ensure that pharmacy-based overdose prevention practices are widely available to all individuals.

Objective: : This study aims to assess the extent to which disposal programs and same-day naloxone have been implemented in pharmacies across the United States and examine neighborhood characteristics in implementation. We hypothesize that as neighborhood disadvantage and the proportion of Black or African American residents in a neighborhood increase, the likelihood of a pharmacy having a disposal program or same-day naloxone decreases. We also hypothesize differences in medication disposal programs and same-day naloxone availability by retailer chain and type of pharmacy.

Methods: A secret shopper caller protocol will be used to identify pharmacies that have implemented a medication disposal program and have naloxone available on the same day without a prescription. We will conduct disproportionate stratified random sampling with the strata being pharmacy chains to maximize the likelihood of sampling corporations and independent pharmacies. The goal is to obtain a final sample of 1000 pharmacies. Neighborhood characteristics will be appended to the secret shopper data. To explore neighborhood and pharmacy characteristics associated with the availability of medication disposal programs and same-day naloxone, we will use logistic regression. This protocol represents the entire structure of the secret shopper caller approach.

Results: Data collection was completed in the spring of 2024. The expected results will be published in 2025.

Conclusions: This will be the first study to examine national estimates of medication disposal programs, same-day naloxone availability at pharmacies, and the geographic characteristics associated with their implementation.

International registered report identifier (irrid): DERR1-10.2196/64344.

Keywords: disposal; harm reduction; medication disposal; mystery caller; naloxone; naloxone availability; opioid; opioid disposal; pharmacy; protocol; secret shopper.