An Ecological Analysis of Co-Locating Buprenorphine and Naloxone Provision at Pharmacies in New York City: Implications for Harm Reduction Practice and Policies

Background and Purpose: The following study estimated the association between pharmacy and community-level factors and likelihood of providing buprenorphine and naloxone in a sample of pharmacies in New York City. This study hypothesized that pharmacies in neighborhoods with greater rates of poverty, food insecurity and unmet medical needs would be less likely to provide both buprenorphine and naloxone compared to pharmacies in neighborhoods with greater rates of poverty and food insecurity. This study also hypothesized that pharmacy-level factors including private spaces to consult with pharmacists, knowledge of where to refer people when out of stock of naloxone as well as neighborhood-level racial and ethnic composition will be associated with greater likelihood of carrying both naloxone and buprenorphine.

Methods: Data were collected by recruiting a cross-sectional convenience sample of 662 pharmacies off the New York City Naloxone Standing Order Pharmacy list to complete a survey by phone. Surveys assessing availability of naloxone and buprenorphine, and characteristics of the pharmacy. A multinomial variable was created measuring if the pharmacy provided 1) no buprenorphine or naloxone, 2) naloxone only, 3) buprenorphine only and 4) both buprenorphine and naloxone.

A multilevel multinomial regression analysis using generalized structural equation modeling estimated the association between private spaces to consult with pharmacists, knowledge of where to refer people when out of stock of naloxone, as well as neighborhood-level racial and ethnic composition, rates of poverty, food insecurity, unmet medical needs and likelihood (Relative Risk, RR) of providing naloxone only, buprenorphine only and both buprenorphine and naloxone.

Results: More than a third of pharmacies co-located buprenorphine and naloxone (38.67%, n=256), provided only naloxone (40.03%, n=265) and 5.14% (n=34) provided only buprenorphine. Multinomial regression analyses identified significant relationships between the number of private spaces and increased likelihood of provision of buprenorphine and naloxone compared to pharmacies that only provided buprenorphine (RR=3.00 95%CI=1.58, 5.42, <.001), only provided naloxone (RR=1.80, 95%CI=1.22, 2.67, p=.003) and neither naloxone or buprenorphine (RR=4.58, 95%CI=3.08, 6.81, p<.001). Pharmacies that were located in neighborhoods with greater rates of poverty (RR=.14 95%CI=.95, .89, p<.001) and food insecurity (RR=.47, 95% CI=.25, .89, p=.021) were less likely to provide buprenorphine and naloxone compared to pharmacies that provided no buprenorphine or naloxone.

Conclusions and implications: The following study identified economic disparities in the availability of buprenorphine and naloxone in a sample of pharmacies in New York City. Pharmacies are opportune settings for harm reduction by co-locating buprenorphine and naloxone in a single site. Only a third of pharmacies provided both harm reduction interventions and pharmacies in poor neighborhoods were less likely to provide both naloxone and buprenorphine. Findings from this study suggest that more research and funding is needed to ensure that comprehensive harm reduction strategies are equitably distributed in New York City.