A convenience sample was recruited from the 4644 currently practicing community pharmacists who had a valid email address on file with the NCBOP. These pharmacists were invited to participate in a 10-min, confidential, online survey. The survey instrument can be found in Additional file 1. Pharmacists were eligible to participate if they currently worked in a community pharmacy setting, defined as a pharmacy that dispenses medications to patients for use at their home (e.g., chain pharmacy, grocery store pharmacy, independent pharmacy, hospital outpatient pharmacy, etc.).
All eligible participants received an email describing the study and a link to the Qualtrics survey. The first page included a study fact sheet containing all elements of informed consent and a survey link. Approximately 2 weeks after the initial email, the first author sent a follow-up email to a random sample of at least three non-responding pharmacists in each county. In addition, this survey was advertised through the North Carolina Association of Pharmacists email listserv. If the county had fewer than three registered pharmacists, all pharmacists were contacted. This approach was chosen to increase geographical representativeness of the sample. Additionally, four reminder emails were sent to the full email list. The survey remained open between March 10, 2022, and May 5, 2022.
Because measures to assess pharmacists’ attitudes toward and willingness to engage in various FTS behaviors did not exist at the time this survey was distributed, new measures were developed to document pharmacist perceptions of barriers to and benefits of selling FTS. Two ‘select all that apply’ questions regarding perceived benefits and barriers of FTS at the pharmacy were created utilizing the previous harm reduction literature [5, 10, 17]. The technical functionality of the 23-item Qualtrics survey was beta-tested prior to distribution.
Pharmacists who voluntarily completed the survey could enter a separate drawing for one of 10 $100 Amazon gift cards. Contact information could not be linked to survey responses. The University of North Carolina at Chapel Hill Institutional Review Board reviewed this study and deemed it exempt from further review.
Pharmacists answered seven multiple-choice demographic questions, including age, gender, years of practice, and practice setting. Pharmacist comfort with initiating a conversation about FTS was measured with one item on a 5-point Likert scale (1 = not at all comfortable; 5 = completely comfortable). Respondents' willingness to advertise, sell, counsel, and distribute FTS instructions, and willingness to refer patients to harm reduction organizations were evaluated with 5 items measured on a 5-point scale (1 = not at all willing, 2 = slightly willing, 3 = somewhat willing, 4 = very willing, 5 = already in practice at my location). Pharmacists were asked to select all that apply with up to seven perceived benefits of selling FTS including: reduce overdose deaths in the community, participate in harm reduction efforts in my community, engage customers that may otherwise feel stigmatized, reduce harm for patients when unable to dispense opioids or buprenorphine, new source of revenue for the pharmacy, I do not believe there are any benefits to selling FTS; other). Pharmacists indicated perceived barriers to selling FTS through a ‘select all that apply’ question, from a list of eight barriers: unaware of where to order FTS, discomfort initiating a conversation about FTS, concern for legality, do not want to attract individuals with substance use disorder (SUD) to my pharmacy, lack of time to educate about FTS, identifying patients who would benefit from FTS, lack of interest in selling FTS, other). One question assessed pharmacists' interest in completing an FTS training (with responses ranging from 1 = not at all interested to 4 = very interested).
IBM SPSS Statistics (Version 26) was used to analyze the data. Descriptive statistics, including frequencies and means, were used to characterize the sample and variables of interest.