Author ORCID Identifier
https://orcid.org/0000-0002-9413-7002
Date of Award
Summer 2026
Document Type
Thesis (Ph.D.)
Department or Program
Health Policy and Clinical Practice
First Advisor
Lisa A. Marsch, PhD
Abstract
Statement of the Problem. Naloxone, a short-acting opioid antagonist, reduces overdose mortality among people prescribed medications for opioid use disorder (MOUD), yet co-prescribing remains low. Pharmacist integration within care teams is a promising but understudied strategy for increasing naloxone access. This dissertation characterized naloxone access across four primary care and co-located pharmacy sites participating in the NIDA Clinical Trials Network CTN-0116 study examining the implementation and impact of a pharmacist-integrated MOUD model.
Methods. The Consolidated Framework for Implementation Research (CFIR) informed data collection across all studies. Study 1 characterized the outer setting through 24 care team interviews on overdose perceptions, 2018-2023 overdose trends, and state opioid overdose reversal medication (OORM) laws and Medicaid coverage. Study 2 examined care team attitudes and knowledge of naloxone and harm reduction at launch, 6, and 12 months with 30 care team members (80 interviews). Study 3 combined logistic regression of 36,537 encounters (1,828 patients prescribed MOUD, 2021-2024) with thematic analysis of 33 patients (55 interviews) at launch and 6 months to examine co-prescribing trends alongside patient experiences of naloxone.
Results. Study 1 found perceptions of drug overdose were high at the state and community level but variable within clinical settings, with heterogeneity in state OORM laws and Medicaid coverage. Study 2 identified four themes. Attitudes toward naloxone shifted from early ambivalence to acceptance at the individual level, while comfort with additional harm reduction tools varied. Knowledge of naloxone and harm reduction improved but remained inconsistent by role, prior training, and experience, particularly regarding over-the-counter (OTC) naloxone. Communication between care team members and integrating naloxone into the daily clinic workflow facilitated prescribing. External factors, including OTC naloxone availability, cost concerns, and insurance coverage, influenced access. Study 3 identified a year-over-year increase in naloxone co-prescribing (OR = 1.14, 95% CI: 1.03-1.25) and revealed access gaps, including OTC affordability and preference for obtaining naloxone at their primary care and co-located pharmacy compared to external pharmacies where stigma persisted.
Conclusions. Pharmacist integration in primary care shows promise for normalizing naloxone co-prescribing. Aligning state policy, insurers, health systems, and care team education will be critical to increase naloxone access for people prescribed MOUD.
Recommended Citation
Boggis, Jesse S., "Characterizing Naloxone Access During the Implementation of Pharmacist-Integrated Opioid Use Disorder Treatment in Primary Care" (2026). Dartmouth College Ph.D Dissertations. 537.
https://digitalcommons.dartmouth.edu/dissertations/537
