Knowledge Without Action? Examining Rural Community Pharmacists’ Knowledge and Practices in Opioid Overdose Prevention and Treatment Services

Background: Rural communities often face higher rates of opioid-related harm but fewer resources to address risk. Pharmacies in these areas are critical for opioid overdose prevention and treatment for opioid use disorder (OUD) as they may serve as patients’ only healthcare access point. Pharmacists in these communities can provide opioid overdose-related education, counseling for OUD, and follow-up care. However, little is known about pharmacists’ knowledge and practices regarding the delivery of these services. It remains unclear to what extent rurality or pharmacist years of practice experience influence knowledge and practices related to opioid overdose treatment and prevention. Methods: A cross-sectional survey was disseminated to 150 pharmacists in the Rural Research Alliance of Community Pharmacies (RURAL-CP). The survey contained 20 items, which included demographic, knowledge-based, and practice-based questions. Results: The survey had a 52% response rate (n=78). Participating pharmacists demonstrated strong baseline knowledge related to naloxone and buprenorphine. Regarding rurality, no significant difference in pharmacists' composite knowledge scores based on RUCA code was found (p=0.12). Neither rurality nor years of practice experience were significantly associated with the offering of naloxone, overdose counseling, or the dispensing of buprenorphine and naloxone. Only 10.3% of pharmacists always provided overdose counseling and only 1% of pharmacists always offered naloxone to patients filing an opioid prescription. Conclusion: This is the first multi-state study to provide a comprehensive look at the knowledge and practices related to opioid overdose prevention and treatment services for OUD across rural community pharmacists in the Southeastern United States. While no major differences in knowledge based on rurality or practice experience were found, there was low implementation of key overdose prevention practices in these pharmacies, particularly overdose counseling and naloxone offering. These findings highlight that the barriers are not related to pharmacist knowledge, but rather service implementation.