Knowledge, attitudes and practices among Australian community pharmacists towards naloxone and overdose prevention: a national cross-sectional study

INTRODUCTION: Naloxone is an opioid overdose reversal drug that is available for free without a prescription via participating community pharmacies in Australia. AIM: To investigate Australian community pharmacists' knowledge, attitudes, practices, and provision of naloxone and overdose prevention, and identify barriers to and correlates of naloxone provision. METHOD: Data were collected between January and April 2025 via an anonymous, cross-sectional questionnaire among Australian community pharmacists who were recruited using a randomised representative sampling approach. Data pertaining to pharmacy and pharmacist-related characteristics, pharmacists' knowledge and attitudes towards naloxone, overdose prevention, and provision of naloxone, including barriers to provision, were captured. Multivariable logistic regression was conducted to determine the pharmacy (including jurisdiction, geographic location, pharmacy type, and provision of other harm reduction services) and pharmacist (including gender, years of experience, knowledge of, and attitudes towards naloxone and overdose prevention) characteristics associated with stocking naloxone. RESULTS: Of the 730 pharmacists who completed the online questionnaire, approximately three-quarters (n = 534, 73.2%) stocked naloxone. Most pharmacists had positive attitudes towards naloxone (85%), and good or excellent self-reported knowledge (81%) of naloxone and overdose prevention. Logistic regression analyses revealed that pharmacies that had significantly greater odds of stocking naloxone were located in Australia's least populous states/territories (Australian Capital Territory, Northern Territory, Tasmania, South Australia) (aOR: 2.32; 95% CIs 1.17-4.61) and Queensland (aOR: 2.12; 95% CIs 1.17-3.83), provided Opioid Agonist Treatment (aOR: 2.77; 95% CIs 1.82-4.24), and had pharmacists with good or excellent knowledge of naloxone (aOR: 4.43, CIs 2.75-7.12; aOR: 6.19, CIs 3.53-10.84 respectively) and very positive attitudes towards naloxone supply (aOR: 2.29, 95% CIs 1.23-5.25). Lack of time to develop, implement and/or sustain the program (59.4%) and lack of training among pharmacy staff (44.6%) were identified as key barriers among the minority of pharmacists that did not stock naloxone. CONCLUSION: A large proportion of community pharmacies in Australia stocked naloxone, with variability across states/territories. While pharmacists' attitudes and knowledge were positive overall, there remains scope to increase provision of adequate education and targeted support to strengthen community pharmacies' harm reduction capacity and provide equitable access.