Pharmacists in Kosova Know Opioid Risks but Hesitate on Naloxone, Survey Finds

Community pharmacies are often the most accessible point of contact in a healthcare system, and in Kosova they may be the first place where signs of opioid misuse become visible. A new cross-sectional survey of 460 community pharmacy professionals across the country suggests that while awareness of opioid abuse is high and attitudes toward prevention are largely positive, confidence in one of the most critical harm reduction interventions, administering the overdose reversal drug naloxone, lags noticeably behind. The findings, published in the journal Pharmacia, reveal a gap between what pharmacy professionals know and what they feel prepared to do, a gap the authors argue could be narrowed through practical training and clearer regulatory guidance.

The study, conducted from June to November 2025, used a structured online questionnaire distributed through pharmacy-related social media groups and professional pages across Kosova. Participants included pharmacists and pharmacy technicians directly involved in dispensing medicines and counseling patients. The 29-item instrument covered demographic and professional background, awareness of opioid abuse and misuse, attitudes toward counseling and harm reduction, reported practices, and self-reported confidence related to naloxone administration. Most participants were female (75.8 percent), aged 19 to 30 (57.7 percent), and held a Master of Pharmacy degree (65.4 percent). More than half reported one to four years of work experience, and most worked full time in urban pharmacies.

The results paint a picture of a workforce that is well informed on paper. A striking 93.5 percent of respondents reported understanding the difference between opioid abuse and opioid misuse, terms that carry distinct clinical meanings: misuse refers to using prescription opioids in a manner other than prescribed, while abuse refers more broadly to harmful or non-medical opioid use. Familiarity with naloxone and its mechanism of action was reported by 81.5 percent of participants. Internal consistency of the awareness items was good, with a Cronbach’s alpha of 0.81, suggesting the questions reliably captured a coherent construct of self-reported knowledge.

Attitudes toward professional involvement were similarly encouraging. Three quarters of respondents (75.8 percent) agreed that pharmacies are appropriate settings for counseling individuals suspected of opioid abuse, and 75.1 percent said they were willing to provide such counseling. Support for dispensing opioids only with a valid medical prescription was nearly universal at 93.5 percent, and 94.6 percent agreed that pharmacy professionals should not sell medications to individuals who appear to be abusing them. Almost all respondents (95.0 percent) agreed that pharmacy staff should be trained to recognize individuals with substance misuse, and 98.5 percent said staff should be informed about medications with abuse potential. The attitude scale showed acceptable internal consistency with a Cronbach’s alpha of 0.76.

Yet beneath these positive surface indicators, the survey exposed significant vulnerabilities. Only 56.2 percent of participants reported feeling either confident enough or very confident in administering naloxone in their pharmacy setting, while 43.8 percent reported not feeling confident at all. This is a substantial proportion of a workforce that, in many countries, is increasingly expected to serve as a frontline response to opioid overdose. More than half of respondents (54.2 percent) also expressed concern that administering naloxone would require more time than they could provide in routine pharmacy practice, pointing to workflow pressures as an additional barrier beyond knowledge alone.

Work experience emerged as a meaningful variable across multiple measures. Chi-square tests revealed statistically significant associations between years of practice and several responses, including views on prescription-only opioid dispensing (p = 0.013), training in recognizing substance misuse (p = 0.040), naloxone-related education (p = 0.001), and time constraints around naloxone administration (p = 0.027). Most notably, self-reported confidence in administering naloxone was significantly associated with work experience (p = 0.017), and familiarity with naloxone showed an even stronger association (p = 0.001). These findings align with previous international research suggesting that more experienced pharmacists often report greater comfort when addressing opioid-related situations and engaging in patient counseling.

The regulatory context in Kosova adds a layer of complexity that the authors emphasize. Although national legislation governs medicinal products and retail pharmacy services, the current framework does not explicitly provide community pharmacists or pharmacy technicians with the authority to administer naloxone. This means that participants’ responses regarding confidence in naloxone administration should be understood as perceptions of a potential role rather than reflections of established practice. The authors note that this regulatory uncertainty is particularly relevant when assessing pharmacy professionals’ willingness and confidence to participate in opioid overdose management, and that clearer professional and regulatory guidance may be needed to address the gap.

Not all findings were uniformly positive. While 78.1 percent of respondents reported suggesting safer alternatives when misuse was suspected, only 31.9 percent reported contacting nearby pharmacies to inform them of an individual suspected of opioid misuse. This pattern, in which pharmacists feel comfortable with individual counseling but hesitate when broader professional collaboration is required, has been observed in other studies and may reflect barriers to inter-professional communication that were not directly examined in the present research. Additionally, 38.5 percent of participants agreed that the sale of controlled medications without a prescription represents an important source of pharmacy income, a finding the authors say should be interpreted cautiously as it reflects perceptions rather than dispensing practices.

The study has several limitations that shape how the results should be read. The cross-sectional design captures attitudes at a single point in time and cannot establish causality. Responses were self-reported rather than directly observed, meaning actual behavior and practical competence may differ from what participants described. Social desirability bias may have influenced answers to questions about professional responsibility and ethical practice. The voluntary online recruitment through social media may have attracted pharmacy professionals with a stronger interest in public health, potentially skewing responses toward more positive attitudes. The questionnaire was developed specifically for this study without formal pilot testing, and confidence in naloxone administration was assessed using a single item. Pharmacists and pharmacy technicians were also analyzed together without separate analysis by professional qualification.

Despite these limitations, the findings carry practical weight for a region where empirical evidence on pharmacy involvement in opioid harm reduction has been scarce. The authors conclude that strengthening the role of community pharmacy professionals in opioid abuse prevention will require more than awareness alone. Practice-oriented training, clear professional guidance, and supportive regulatory frameworks are needed to translate positive attitudes and self-reported knowledge into genuine confidence at the counter. International evidence suggests that successful pharmacist involvement in opioid harm reduction is most likely when training, regulatory clarity, and institutional support are aligned, and in settings where access to specialized addiction services is limited, community pharmacies may represent one of the most promising settings for early identification of opioid-related concerns and overdose prevention.

Subject of Research: Community pharmacists' awareness, attitudes, and confidence regarding opioid abuse and naloxone use in Kosova

Article Title: Community pharmacists’ awareness, attitudes, and confidence regarding opioid abuse and naloxone use in Kosova: A cross-sectional survey

Article References: Ibraimi, Z., Haxhiu, A., Shabani, D., Qeriqi, V., Bresa, A., & Haliti, D. (2026). Community pharmacists’ awareness, attitudes, and confidence regarding opioid abuse and naloxone use in Kosova: A cross-sectional survey. Pharmacia, 73, Article e204449. https://doi.org/10.3897/pharmacia.73.e204449

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e204449

Keywords: opioid abuse, naloxone, community pharmacists, Kosova, harm reduction, cross-sectional survey, Community, pharmacists, awareness, attitudes, confidence, regarding