Assessing pharmacy student experience with, knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction

Defining a public health approach to substance use: Perspectives from professionals and practitioners across Canada

BACKGROUND

While increasingly referenced in the literature and policy discussions, a "public health approach" (PHA) to substance use has been inconsistently defined or remained undefined. As part of a larger project on building the capacity to implement a PHA to substance use, we aimed to understand how professionals and practitioners across Canada who work with or whose work directly impacts the lives of people who use substances conceptualize a PHA.

METHODS

We conducted a cross-sectional national online survey of public health professionals, public safety professionals, health and social service providers, and other relevant professionals and practitioners. The survey contained closed- and open-ended questions designed to gauge familiarity and comfort with application of a PHA to substance use, and perspectives on an organizational definition of such an approach. Survey recruitment was active between May and July 2021. Data analysis included descriptive statistics and thematic analysis.

RESULTS

A total of 1041 surveys were completed. Most respondents (76 %) reported having heard of a PHA to substance use, as it was defined. Over half (54 %) indicated a high level of comfort with applying such an approach within their work. In relation to defining a PHA to substance use, the following thematic suggestions emerged from respondent's open-ended answers: explicitly recognize people with lived/living experience of substance use; incorporate trauma-informed understanding and acknowledge the varied underlying reasons for substance use; decolonize approaches to substance use and empower communities; and consider a more critical appraisal of a PHA and the terminology in its definition.

CONCLUSION

Empirically unpacking multi-stakeholder understandings of a PHA to substance use can help to inform a more cohesive definition and build the consensus needed for more effective, coordinated, and community-led responses to substance use. Future work, especially qualitative research, will provide richer and more practical understandings of a PHA to substance use.

High-dose naloxone formulations are not as essential as we thought

Naloxone is an effective FDA-approved opioid antagonist for reversing opioid overdoses. Naloxone is available to the public and can be administered through intramuscular (IM), intravenous (IV), and intranasal spray (IN) routes. Our literature review investigates the adequacy of two doses of standard IM or IN naloxone in reversing fentanyl overdoses compared to newer high-dose naloxone formulations. Moreover, our initiative incorporates the experiences of people who use drugs, enabling a more practical and contextually-grounded analysis. The evidence indicates that the vast majority of fentanyl overdoses can be successfully reversed using two standard IM or IN dosages. Exceptions include cases of carfentanil overdose, which necessitates ≥ 3 doses for reversal. Multiple studies documented the risk of precipitated withdrawal using ≥ 2 doses of naloxone, notably including the possibility of recurring overdose symptoms after resuscitation, contingent upon the half-life of the specific opioid involved. We recommend distributing multiple doses of standard IM or IN naloxone to bystanders and educating individuals on the adequacy of two doses in reversing fentanyl overdoses. Individuals should continue administration until the recipient is revived, ensuring appropriate intervals between each dose along with rescue breaths, and calling emergency medical services if the individual is unresponsive after two doses. We do not recommend high-dose naloxone formulations as a substitute for four doses of IM or IN naloxone due to the higher cost, risk of precipitated withdrawal, and limited evidence compared to standard doses. Future research must take into consideration lived and living experience, scientific evidence, conflicts of interest, and the bodily autonomy of people who use drugs.

Pharmacy Student Education Related to Opioids: A Scoping Review of the Literature

OBJECTIVES

This scoping review explores and assesses the extent of the literature on the current state of opioid-related training and education of student pharmacists and identifies areas for further research to improve the preparedness of future pharmacists in managing care for patients using opioid medications. This review also examines and maps the literature as it relates to the 4 substance misuse educational content areas (legal/ethical issues; screening, treatment, and stigma; pharmacology and toxicology; and psychosocial aspects) recommended by the 2020 American Association of Colleges of Pharmacy Special Committee on Substance Use and Pharmacy Education.

FINDINGS

A systematic literature search was conducted to identify articles reporting opioid-related educational and training initiatives for student pharmacists in the United States through May 2023. A total of 52 articles were included in the review. Nearly 40% of the included studies reported content that addressed all 4 recommended content areas, with only 8 addressing only 1 or 2 content areas. The majority of studies included students in the third year of their pharmacy program, with many reporting interprofessional educational initiatives. Assessments of opioid-related knowledge and attitudes, satisfaction with the activity, and interprofessional attitudes and competencies were reported.

SUMMARY

Most of the reported activities addressed at least 3 of the recommended educational content areas. However, relatively few reported sufficient details to support the replication of the activities and there is a need to evaluate the effectiveness of these educational initiatives with more vigorous research methodology to determine their potential effectiveness.

Professional stigma towards clients with methamphetamine use disorder - a qualitative study

Background

Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD.

Methods

A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team.

Results

Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD.

Conclusion

A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.

Tolerance, physical dependence, and addiction: Knowledge gaps and misconceptions of first-year pharmacy students

INTRODUCTION

Misconceptions related to terminology used in the diagnosis and treatment of substance use disorders are common among healthcare providers and may contribute to inappropriate management and education of patients. The objective of this study was to evaluate baseline knowledge of addiction, tolerance, and physical dependence in first-year pharmacy students completing a unit on the neurobiological basis of addiction.

METHODS

Students were asked to define the terms addiction, tolerance, and dependence at the beginning of a didactic unit on nervous system pathophysiology and pharmacology. Handwritten responses were transcribed to a spreadsheet and deidentified by sequential assignment to a single numeric identifier. Data were analyzed by three reviewers through open coding and thematic analysis. Descriptive statistics were used to describe the results.

RESULTS

One hundred eighty-seven individual student submitted responses were included in the analysis. Many students were unable to provide a substantive definition for the terms physical dependence (32%) and addiction (27%). The definition of tolerance was partially correct in >80% of student responses, though no students provided a complete description. Approximately 5% of students defined physical dependence as addiction, and > 18% incorrectly attributed withdrawal symptoms to addiction.

CONCLUSIONS

Significant knowledge gaps or misconceptions regarding terminology related to substance use disorder exists among first-year pharmacy students despite continuing efforts within professional organizations to develop consensus definitions. Developing effective teaching methods to identify and correct misinformation and preconceptions related to care for patients with substance use disorders should continue to be a priority for pharmacy educators.

Impact of a Didactic-Experiential Naloxone Learning Model to Improve Student Pharmacist Skills and Patient Care

OBJECTIVE

To assess the impact of an integrated didactic-experiential learning model on student pharmacists' knowledge, confidence, comfort, and intention regarding provision of naloxone for patients receiving opioid therapy.

METHODS

An integrated didactic-experiential learning model was developed to bridge learning in the classroom and laboratory with application in the experiential setting. Student knowledge, confidence, comfort, and intentions regarding provision of naloxone services were measured via online survey at predidactic, postdidactic, and postexperiential time points, and analyzed using Friedman's analysis of variance.

RESULTS

A total of 280 first-year student pharmacists completed the baseline survey. The learning model increased student knowledge, confidence, comfort, and intention regarding naloxone services implementation. Specifically, students reported an increase in mean (SD) knowledge score from 60.85% (17.40%) in the predidactic to 81.47% (13.57%) in the postdidactic period. Similarly, mean (SD) confidence (2.49 [0.75] to 3.56 [0.45]), comfort (2.06 [0.74] to 3.57 [0.45]), and intention (3.46 [0.70] to 3.66 [0.44]) increased from pre- to postdidactic period, and these changes were maintained from postdidactic to postexperiential period.

CONCLUSION

The didactic-experiential learning model increased student knowledge, confidence, comfort, and intentions regarding naloxone services implementation. We believe that the model fills gaps in student pharmacist education and is the first step in enhancing and sustaining community pharmacy-based naloxone services. Although this study was limited to a single college, it shows the effectiveness of linking didactic and experiential training in improving students' knowledge and skills.

Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study

Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.

Temporal Reinforcement of Naloxone Training Results in Significant Retention of Anti-bias and Overdose-Response Knowledge

BACKGROUND

The opioid epidemic is an increasingly severe problem affecting public health and leading to significant economic burdens on healthcare systems. Overdose reversal training and de-stigmatization efforts are common strategies used to combat this epidemic. Nevertheless, healthcare professionals report a lack of confidence in administering naloxone and high stigmatization levels toward people with opioid use disorder (OUD). While one-time educational training reduces stigma and improves naloxone administration confidence, we previously demonstrated that knowledge retention at a three-month follow-up is reduced among a cohort of medical students. This study aimed to improve the effectiveness of opioid overdose awareness and reversal training (OOART) with a three-month follow-up abbreviated OOART (aOOART) booster video.

METHODS

Voluntary OOART was offered to first-year medical students (M1) at the Drexel University College of Medicine in 2022. At this training, 82 students completed a pre-training survey to establish a baseline knowledge and attitude toward people with OUD and their familiarity with the steps to reverse an opioid overdose. Following the hour-long training, 64 of 82 (79%) participants completed the post-training survey to measure the immediate retention of training information. After 2.5 months, students were randomly selected to receive a 6.5-minute aOOART booster video or serve as an unboosted control. Students in the booster and non-booster cohorts then completed a three-month follow-up survey.

RESULTS

 Students who received the aOOART booster had significantly increased opioid reversal knowledge scores compared to non-boosted control students at the three-month follow-up. The aOOART booster resulted in a retention of the lowered stigma, and participants expressed a higher willingness to respond to an opioid overdose compared to participants who did not receive the booster video at the three-month follow-up.

CONCLUSIONS

 This study shows that an aOOART booster method improves knowledge retention following initial OOART. Further, the aOOART booster video served to maintain participants' reduced stigma toward people with OUD and maintained participants' willingness to respond to an opioid overdose. These results support the incorporation of an abbreviated, periodic OOART reinforcement video into opioid overdose response training nationwide. We believe this "booster video" approach is a novel and effective method to improve healthcare professionals' and medical student preparedness to render appropriate care to people with OUD.

Readiness of community pharmacies to implement an opioid safety intervention

BACKGROUND

We report on efforts to measure readiness to adopt opioid safety initiatives in community pharmacies within 2 large chains. Previous studies identified lack of knowledge, confidence, or enthusiasm in addressing harm reduction efforts. We implemented an intervention that provided training to improve opioid safety. The goal was to increase naloxone prescribing and nonprescription syringe sales, reduce stigma, and decrease opioid overdoses among patients and customers.

OBJECTIVES

To assess pharmacy readiness for intervention delivery, by characterizing pharmacy culture around opioid safety; describing current practices and challenges interacting with patients and customers on naloxone, nonprescription syringe sales, and buprenorphine; and determining pharmacy defined goals for implementing the intervention.

METHODS

The sample included pharmacy managers and staff pharmacists from 2 large chains who completed a brief phone interview. Interviews consisted of Likert-scale and open-ended, theoretically driven questions. Questions focused on workplace culture, patient engagement, naloxone and buprenorphine prescribing, nonprescription syringe sales, and intervention goals. Coding categories for the open-ended questions were derived using a thematic review of responses.

RESULTS

A total of 163 respondents described both workplace culture and how they encourage patient opioid safety as including public health awareness, patient engagement, and naloxone prescribing. Sale of nonprescription syringes exhibited high variability: no sales barriers (53.9%), sales with barriers (21.5%), and no sales (20.9%). Half of pharmacists (50.3%) interacted with buprenorphine prescribers outside of medication fills. Most respondents (68.7%) endorsed being ready to promote the intervention. Pharmacists named goals in adopting the intervention of wanting more knowledge and educational materials, talking points with patients, and best practices for offering naloxone.

CONCLUSION

Community pharmacists, before implementation, described awareness of and receptiveness to opioid safety initiatives, with substantial barriers around nonprescription syringe sales. Assessed knowledge level, culture, and identified barriers that emerged in the readiness assessments can be used to tailor future pharmacy-specific programming.

Assessing Student Readiness to Work with People Who Use Drugs: Development of a Multi-disciplinary Addiction Educational Survey

BACKGROUND

As health profession schools implement addiction curricula, they need survey instruments to evaluate the impact of the educational interventions. However, existing measures do not use current non-stigmatizing language and fail to capture core concepts.

OBJECTIVE

To develop a brief measure of health profession student readiness to work with people who use drugs (PWUDs) and establish its content validity.

METHODS

We conducted a literature review of existing instruments and desired clinical competencies related to providing care to PWUD and used results and expert feedback to create and revise a pool of 72 items. We conducted cognitive interviews with ten pre-clinical health profession students from various US schools of nursing, pharmacy, and medicine to ensure the items were easy to understand. Finally, we used a modified Delphi process with twenty-four health professions educators and addiction experts (eight each from nursing, pharmacy, and medicine) to select items for inclusion in the final scale. We analyzed expert ratings of individual items and interdisciplinary agreement on ratings to decide how to prioritize items. We ultimately selected 12 attitudes and 12 confidence items to include in the REadiness to Discuss Use, Common Effects, and HArm Reduction Measure (REDUCE-HARM). Experts rated their overall assessment of the final scale.

RESULTS

Twenty-two of twenty-four experts agreed or strongly agreed that the attitudes scale measures student attitudes that impact readiness to work with PWUDs. Twenty-three of twenty-four experts agreed or strongly agreed that the confidence scale measures student self-efficacy in competencies that impact readiness to work with PWUDs. Seven of 72 initial items and none of the 24 selected items had statistically significant differences between disciplines.

CONCLUSIONS

The REDUCE-HARM instrument has strong content validity and may serve as a useful tool in evaluating addiction education. Additional research is needed to establish its reliability, construct validity, and responsiveness to change.

Comparing Practices Used in Overdose Fatality Review Teams to Recommended Implementation Guidelines

OBJECTIVES

Overdose fatality review teams are a public health and public safety collaboration that reviews fatality cases using a multidisciplinary team to provide recommendations for overdose prevention. No research exists on the case review practices currently being used in these programs.

DESIGN

We administered a cross-sectional survey measuring case review practices and perceptions to a convenience sample of overdose fatality review teams.

SETTING

We administered the online survey to participants at a national virtual forum on overdose fatality review.

PARTICIPANTS

In this study, we examined 30 county-level overdose fatality review teams from 6 states who completed the survey.

MAIN OUTCOME MEASURES

We developed measures of case review practices from an overdose fatality review implementation guide. We provided descriptive statistics on the survey items used to measure these practices and examined how practice uptake varied by overdose fatality review team characteristics.

RESULTS

Most overdose fatality review teams had adequate representation and membership, but none adhered to all of the practices measured from the implementation guide. The largest gap was in perceived effectiveness and implementation of case review recommendations. In addition, teams that had been reviewing cases for longer reported more adherence to recommended practices.

CONCLUSIONS

Overdose fatality case review is a collaboration between local public health and public safety agencies that holds great promise. However, these teams will require additional training and technical assistance with local community support to ensure that recommendations are actionable.

Acceptability of a Fentanyl Vaccine to Prevent Opioid Overdose and Need for Personalized Decision-Making

BACKGROUND

The opioid epidemic worsened during the coronavirus disease 2019 (COVID-19) pandemic. Synthetic opioids (primarily fentanyl) comprise the most common drugs involved in overdose (OD) death. A vaccine that blocks fentanyl from reaching the brain to prevent OD is under development, and insight is needed into its acceptability.

METHODS

Using a semi-structured interview guide, persons with opioid use disorder (OUD), family, professionals, and the public were interviewed about attitudes and concerns regarding a fentanyl vaccine. Reactions to fictional clinical vignettes of persons at risk of OUD because of pain and/or substance use histories were collected, analyzed, and quantified for favorability. Interviews were transcribed, coded, and analyzed thematically.

RESULTS

Among N = 64 participants, (70.3% female, average age 32.4 years), attitudes were favorable toward a fentanyl vaccine, with preference for lifelong durability (76% of n = 55 asked). Perceived benefits centered on the potential for a life-saving intervention, suffering averted, healthcare dollars saved, and the utility of a passive harm reduction strategy. Concerns centered on uncertainty regarding vaccine safety, questions about efficacy, worry about implications for future pain management, stigma, and need for supportive counseling and guidance to personalize decision making. Reactions to vignettes revealed complex attitudes toward fentanyl vaccination when considering recipient age, health history, and future risks for addiction and pain.

CONCLUSIONS

Positive responses to a fentanyl vaccine were found along with appreciation for the complexity of a vaccine strategy to prevent OD in the setting of pain and uncertain durability. Further research is needed to elucidate operational, ethical, and communications strategies to advance the model.

A longitudinal study of naloxone opioid overdose awareness and reversal training for first-year medical students: specific elements require reinforcement

Background

The opioid epidemic is a progressively worsening public health crisis that continues to impact healthcare system strategies such as overdose reversal and destigmatization. Even among healthcare professionals, there remains a lack of confidence in naloxone administration and a prevalence of stigma. While training can play a major impact in reducing these shortcomings, the long-term effectiveness has yet to be characterized in training healthcare professionals. This study examined the long-term retention of opioid overdose awareness and reversal training (OOART) by evaluating performance at two-time intervals, immediately post-training and at a 3-month follow-up.

Methods

Voluntary training was offered to first-year (M1) medical students at the Drexel University College of Medicine in 2021. At this training, 118 students completed training, 95 completed the post-training survey, and 42 completed the 3-month follow-up.

Results

Opioid reversal knowledge questions assessed significantly increased scores post-training and at the 3-month follow-up. In three of the attitude questions, scores were improved at both follow-up timepoints. In addition, three attitude questions indicating a participant’s confidence to respond to an opioid overdose situation increased directly after the training, but regressed at the 3-month follow-up. The remaining questions did not show any statistical difference across the survey intervals.

Conclusions

This study establishes that while OOART provides participants with the knowledge of how to respond to an opioid overdose, the retention of this knowledge at a 3-month interval is reduced. The results were mixed for longitudinal assessment of participant’s attitudes toward people with opioid use disorder. Some positive increases in attitudes were retained at the 3-month interval, while others trended back toward pre-training levels. These results support the effectiveness of the training but also provide evidence that OOART must be reinforced often.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12954-022-00656-y.

Opioid harm reduction: A scoping review of physician and system-level gaps in knowledge, education, and practice

Background: Harm reduction includes treatment and prevention approaches rather than abstinence, as a public health strategy for mitigating the opioid epidemic. Harm reduction is a new strategy for many healthcare professionals, and gaps in knowledge and practices may lead to barriers to optimal treatment. Our objective was to identify and describe gaps in physicians' knowledge, education, and practice in harm reduction strategies related to opioid overdose. Methods: We searched the PubMed, CINAHL, and Web of Science databases for articles published between 2015 and 2021, published in English, containing empirical evidence, addressing opioid harm reduction, and identifying gaps in physicians' knowledge, education, or practice. Results: Thirty-seven studies were included. Studies examined how physicians' perceptions or stigma influenced harm reduction efforts and addressed clinical knowledge gaps in overdose treatment and prevention and OUD treatment. Less than half of the studies addressed access issues at the system level, above the individual healthcare professional. Conclusion: Individual-level interventions should be addressed with professional continuing education and curricular-based changes through experiential and interprofessional education. System-level gaps can be remedied by increasing patient access to care, creating policies favorable to harm reduction, and extending resources to provide harm reduction strategies.

Expanding naloxone education in the doctor of pharmacy curriculum

INTRODUCTION

Pharmacists are well-positioned to provide patients with access to the opioid-induced breathing emergency reversal agent naloxone, but many do not feel they have received adequate training to do so. The purpose of this project was to develop, implement, and evaluate an enhanced teaching approach to naloxone education in the doctor of pharmacy (PharmD) curriculum.

METHODS

The educational intervention incorporated active learning, technology, and interprofessional education components. Surveys were developed and administered pre-intervention and at one-week, six-month, and one-year post-intervention to evaluate changes in knowledge, perceptions, and confidence in clinical skills related to opioid-induced breathing emergencies and naloxone.

RESULTS

After participating, students' confidence (rated 0 to 5) in their ability to administer both intranasal (2.54 vs. 4.37, P < .001) and intramuscular (IM) (2.8 vs. 4.02, P < .001) naloxone increased, which was reflected in their improved performance on an opioid-induced breathing emergency simulation activity. Students ≤25 years old and females experienced significantly greater increases in their confidence to administer IM naloxone than those >25 years old and male. Most of these effects persisted at six months and one-year post-intervention.

CONCLUSIONS

The educational intervention increased pharmacy students' skills and confidence related to opioid-induced breathing emergency and naloxone. Improvements observed were in line with results of similar pedagogical studies. Age and gender differences in self-reported confidence levels also reflected previously reported findings. Materials and methods have been made available for other PharmD programs to utilize in expanding their curricula in these areas.

The Role of Nonprescription Syringe Sales in Ending the Human Immunodeficiency Virus Epidemic

In 2019, the executive branch of the United States released "Ending the Human Immunodeficiency Virus (HIV) Epidemic: A Plan for America" (EHE). EHE proposes to end the HIV epidemic in the United States by 2030. To do so requires a multifaceted effort from all health care providers addressing every possible avenue of HIV transmission. An important aspect of this mission is to increase access to sterile syringes for people who inject drugs (PWID). For many PWID, access to Syringe Service Programs is limited because of hours, location, and state laws. Pharmacies are able to provide clean syringes in a safe, clean, climate-controlled atmosphere with access to a health professional. Although published research shows pharmacist ambivalence toward the nonprescription sales of syringes, pharmacist involvement in states with established guidance and support from departments of health suggests that pharmacists are interested in this public health effort. However, without proper support from departments of health and access to training on the dignified delivery of services, pharmacies will continue to be an ineffective avenue for prevention of HIV spread through the provision of sterile syringes.

Healthcare Professional Students’ Perspectives on Substance Use Disorders and Stigma: A Qualitative Study

Background: Access to and quality of care for Substance Use Disorders (SUDs) remain a major public health issue. Stigma associated with SUDs contributes to the gap between the number of patients who need treatment and the much smaller fraction that receive it. Healthcare professional students are future care providers; an opportunity exists to characterize their collective perspectives on patients with SUDs and how that informs the care they provide. Methods: Healthcare professional students participated in online, semi-structured focus group (FGs) between March and April 2021. The FGs were conducted until thematic saturation was achieved. All verbatim transcripts were analyzed applying Thematic Analysis using Dedoose® qualitative software. Inductive codes were grouped into categories based on similarities that facilitated the emergence of themes. Results: Thematic Analysis revealed one theme (1) Decreasing stigma among healthcare professionals by viewing substance use disorder as a disease; and two sub-themes: Subtheme 1a: Relating with the patients, “It could be me…”; Subtheme 1b: Interactions with patients, “We just don’t know exactly how to counsel these patients…” These themes describe how future healthcare professionals might perceive and approach patients with SUDs and highlight the importance of SUD training in the curriculum. Conclusion: Medical and pharmacy students are uniquely positioned to apply critical thinking from their didactic training to their real-world clinical experiences, and their collective perspectives inform gaps in training and opportunities to develop best practices for SUD care. An opportunity exists to leverage these findings in order to train future healthcare professionals to ensure access to and quality of SUD care.

Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review

The purpose of this review is to examine the existing literature about facilitators and barriers influencing equitable access to naloxone programs by individuals who use opioids. A total of 49 published articles were examined, which generated four overarching themes:(1) Stigma as a barrier to access; (2) Lack of a wide range of stakeholder perspectives; (3) Need for a comprehensive understanding of factors affecting equitable access to naloxone programs; (4) Facilitators to increase the access of community naloxone programs. Our review highlighted the importance of advocacy in practice, education, administration, and policy to address the health inequities that exist in naloxone distribution programs. Advocacy activities involve the need for health care professionals to engage in social justice practice through evidence-based informed research about the facts of opioid use; challenging the stigma toward victim-blaming against naloxone users; as well as promoting program development and health policy to bring about equitable access to naloxone programs by marginalized and socially disadvantaged populations.

The Role of Misinformation and Stigma in Opioid Use Disorder Treatment Uptake

Background: Deaths due to opioid overdose continue to rise in the United States. Despite availability of effective treatment for opioid use disorder, uptake is low among those who misuse opioids. Methods: This paper explores the role of misconception, stigma, and misinformation in influencing decisions to initiate medications for opioid use disorder among patients and providers. Conclusion: Misinformation about opioids has been prevalent among future healthcare providers and first responders as well as pharmaceutical companies, which may have implications for treatment. Among individuals with opioid use disorder, treatment uptake and adherence have been negatively affected by misconceptions about treatment efficacy and side effects, as well as stigma. We discuss the role of social media, education, and the community, in mitigating misinformation and addressing misconceptions about opioids and treatment options.

Combining simulated academic detailing with naloxone training to prepare student pharmacists for opioid risk mitigation strategies

BACKGROUND AND PURPOSE

Academic detailing (AD) is an educational outreach intervention designed to provide clinicians with current evidenced-based education to improve patient care and is effective in mitigating opioid risks. Student pharmacists' abilities to apply naloxone training can benefit from concomitant AD training by highlighting skills needed to effectively assess patient and provider needs and handle objections in a non-biased, evidence-supported manner while reinforcing the application of naloxone administration. Most states have a standing order for pharmacist prescribed naloxone. School of pharmacy clinical science faculty sought to create a combined educational activity teaching naloxone AD in conjunction with hands-on naloxone training to better prepare students to apply the standing order in their future careers.

EDUCATIONAL ACTIVITY AND SETTING

Students in an accelerated pharmacy program applied their AD skills during pharmaceutical skills laboratory activities, emphasizing the use of naloxone administration under the standing order. Students then demonstrated their ability to administer naloxone to a "patient" who experienced an emergency after opioid use.

FINDINGS

While many schools of pharmacy offer either naloxone or AD training to students, none were identified that offered both trainings combined for use with mitigation strategies for opioid management.

SUMMARY

The combination of simulated AD with naloxone administration training was designed as a unique opportunity to foster naloxone education and enhance student understanding and demonstration of naloxone administration. School of pharmacy programs should recognize the opportunity to combine these activities to prepare students for application of statewide naloxone standing orders.

Exploration of pharmacist comfort with harm reduction behaviors: Cross-sectional latent class analysis

BACKGROUND

Pharmacists are positioned to play important roles in implementing evidence-based prevention and harm reduction approaches for opioid misuse and related health care outcomes such as human immunodeficiency virus (HIV) and hepatitis C. More research is needed to understand how best to facilitate harm reduction practices among pharmacists.

OBJECTIVES

This hypothesis-generating study investigated (1) whether subgroups (latent classes) were observable among pharmacists based on self-reported comfort with specific harm reduction behaviors, (2) whether having reported expertise in key content areas was associated with any latent classes that might be identified, and (3) whether comfort and training were associated with actually having dispensed syringes for likely nonprescription drug use.

METHODS

This was a statewide census of community managing pharmacists in Arizona conducted from December 2018 to May 2019. Participants reported their degree of comfort with 10 harm reduction behaviors, their expertise (e.g., recent continuing pharmacy education or specialization) in selected content areas, and their syringe dispensing behavior. Additional sociodemographic information was also collected. Subgroups related to harm reduction were computed using latent class analysis, and associations between study variables were assessed using the Fisher's exact tests.

RESULTS

Data suggested the existence of 4 latent, comfort-based harm reduction classes: high comfort, moderate comfort, and clinical comfort, and opioid prevention only. Reported expertise in pre-exposure prophylaxis for HIV was likely associated with harm reduction class. However, class membership was not associated with reporting having dispensed nonprescription syringes, although the single comfort item for syringe dispensing, by itself, was associated therewith.

CONCLUSION

Comfort with harm reduction likely clusters, so pharmacists may be broadly comfortable with topics or methods of harm reduction; however, comfort with a specific harm reduction pharmacy practice may be a better predictor of engaging in that behavior than harm reduction comfort class. In contrast, strategies to improve comfort, such as intervention development, might successfully be informed by pharmacists' latent class.

"Don't Label Them as Addicts!" Student Pharmacists' Views on the Stigma Associated with Opioid use Disorder

Background:

Student pharmacists represent an important potential population for targeted educational interventions focused on skill and confidence development in order to improve interactions with opioid users and to decrease stigma. The objective of this study was to understand student pharmacists’ perceptions of opioid users.

Methods:

Focus groups were conducted with student pharmacists across Tennessee over two months in 2020. Concepts from the Transtheoretical Mode, Social Cognitive Theory, stigma, and results from a survey sent to student pharmacists were used to develop the open-ended questions. Thematic analysis was conducted to inductively identify main themes. The recruitment of student pharmacists continued until thematic saturation was obtained.

Results:

Three focus groups were conducted with a total of 16 student pharmacists in second, third, and fourth professional years. Thematic analysis revealed two themes: Don’t label them as addicts, Student Insight into OUD-Associated Stigma and five sub-themes: developing a judgment-free environment; unconscious bias; a possible connection between physical appearance and addiction; socio-cultural factors, addiction, and isolation; and motivators to decrease stigma. This study not only presents the pharmacy students experiences and their significance, but also reports their recommendations for addressing the stigma associated with OUD in the pharmacy curriculum.

Conclusions:

These findings highlight the need to normalize appropriate language when describing patients with OUD and avoid negative labels such as “addict.” The findings also indicate where the roots of stigma lie and provide some of the tools to fight stigma on different fronts. Future research should explore and address potential implicit biases throughout pharmacy curriculum.

Report of the 2020 Special Committee on Substance Use and Pharmacy Education

EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.

Pharmacy leaders' beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community

BACKGROUND

Naloxone is an antidote to opioid overdose, and community pharmacies nationwide now provide broad access to this medication.

OBJECTIVE

The aim of this qualitative study was to understand how leaders in pharmacy organizations perceive pharmacies and pharmacy staff can optimize dispensing of naloxone.

METHODS

In-depth interviews were conducted with 12 pharmacy leaders in Massachusetts and Rhode Island. Participants were recruited from three types of community pharmacies: (1) chain; (2) independent; and (3) hospital outpatient. Theory-driven immersion crystallization, using Brownlee et al.'s model of healthcare quality improvement, was used to inform coding of the interview data, with predetermined categories of staff; organization; and process.

RESULTS

Five main themes were identified: (1) Importance of staff training to increase comfort; (2) Strength through coordination of efforts; (3) Pharmacy as a community leader in the opioid crisis; (4) Persisting stigma; and (5) Ongoing workflow challenges.

CONCLUSIONS

The results uniquely reflect the experiences and insights of pharmacy leaders implementing public health initiatives during the opioid crisis and can be used for gaining insight into how pharmacists can efficiently provide naloxone to their communities.

Pharmacy Student Opioid Consultations with Standardized Limited English Proficiency Patients

INTRODUCTION

Limited healthcare studies have analyzed communication practices with limited English proficiency (LEP) patients. Empirical literature lacks evidence about LEP patient-pharmacist communication about opioid risks. This study aimed to (1) explore topics discussed in opioid medication consults, (2) assess if students inform patients about dependency and overdose risks associated with opioid use and the manner in which those risks were introduced and discussed, and (3) assess LEP specific communication practices.

METHODS

Third-year pharmacy students in a required communications course consulted LEP standardized patients (SPs) who spoke 30% English and 70% non-English language. The SP followed a script simulating an encounter between a pharmacist and patient picking up a new, month long prescription of oxycodone. All consultations were video recorded and quantitatively coded for verbal and non-verbal communication skills.

RESULTS

Twenty-three pharmacy students conducted consultations with LEP SPs. The majority of students discussed common side effects, but only a few discussed severe side effects. Four of 23 students named the medication as an "opioid" or "narcotic" and described dependency, overdose, or other opioid specific risks. Students used several filler words, long sentences, and a fast pace. A majority of students used teach back methods to identify patient understanding. Students expressed the need for more structured education and training in providing patient counseling for opioids and communicating with LEP patients.

CONCLUSIONS

Pharmacy students lack confidence and skills in communicating with LEP patients regarding opioid-specific risks, suggesting structured training is needed.

Pharmacy: Addressing substance use in the 21st century

Across all care environments, pharmacists play an essential role in the care of people who use and misuse psychoactive substances, including those diagnosed with substance use disorders. To optimize, sustain, and expand these independent and collaborative roles, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has developed core competencies for pharmacists to address substance use in the 21st century. Key concepts, skills, and attitudes are outlined, with links to entrustable professional activities to assist with integration into a variety of ideally interdisciplinary curricular activities.