Stigma of Opioid Use Disorder and Its Indirect Effects on Student Pharmacists' Perceptions and Attitudes

Community Pharmacists' Knowledge and Attitude Towards Opioid Pain Medication Use in Bahir Dar City, North-West Ethiopia

Background

Opioid use is a major global public health problem, affecting 16 million individuals worldwide. According to a 2023 WHO report, out of the 600,000 substance-related deaths worldwide, 80% were attributed to opioid use. Pharmacists play a vital role in reducing unnecessary opioid exposure while facilitating access to non-opioid alternatives. To do so, pharmacists should have sufficient knowledge regarding opioid-containing medications and a positive attitude about opioid use problems.

Objective

This study aimed to evaluate community pharmacists' knowledge of opioid-containing medications and their attitude toward opioid use problems.

Materials and methods

A cross-sectional study was conducted using a self-administered, structured questionnaire distributed to 105 community pharmacists from July 1-30, 2023 in Bahir Dar City, Ethiopia. The tool included demographic information and questions designed to assess participants' knowledge and attitudes.

Results

Out of the 105 pharmacists included in this study, majority were males (54.3%), nearly half held a bachelor's degree (49.5%), and slightly above one-third had over a decade experience (39%). Regarding knowledge and attitude towards opioids, 62 individuals (59%) exhibited good knowledge, and 64 (61%) demonstrated less stigma toward opioid usage. Factors affecting knowledge include: education level (AOR (95% CI): 8.43 (1.76-40.35) and 9.93 (1.04-85.33) for bachelors and postgraduates respectively and age 1.45 (1.20-1.77)]. Meanwhile, experience [AOR (95% CI): 4.64(1.20-17.90) and 4.29 (1.23-15.05)] for 5-9 years and ≥10 years respectively and education level [AOR (95% CI): 4.08 (1.40-11.93) for bachelors and 6.40 (1.42-28.96)] for postgraduates were linked to attitude.

Conclusion

A gap in knowledge and more stigmatizing behavior was observed among community pharmacists. These findings imply the importance of tailored educational interventions to address knowledge gaps and promote positive attitudes toward opioid usage among community pharmacists. Therefore, it is imperative to deliver up-to-date information on opioids, emphasizing their high addiction potential, to ensure pharmacists are well-equipped with the latest information.

Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature

Introduction

Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data-social media and published literature-to categorize and quantify such barriers.

Methods

In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described.

Results

On social media, the top three insurance-related barriers included having no insurance (22.5%), insurance not covering OUD treatment (24.7%), and general difficulties of using insurance for OUD treatment (38.2%); while the top two non-insurance-related barriers included stigma (47.6%), and financial difficulties (26.2%). For published literature, stigma was the most prominently reported barrier, occurring in 78.9% of the publications reviewed, followed by financial and/or logistical issues to receiving medication treatment (73.7%), gender-specific barriers (36.8%), and fear (31.5%).

Conclusion

The stigma associated with OUD and/or seeking treatment and insurance/cost are the two most common types of barriers reported in the two sources combined. Harm reduction efforts addressing barriers to recovery may benefit from leveraging multiple data sources.

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

Introduction

The opioid overdose crisis has claimed hundreds of thousands of lives in the United States in the last decade, with overdose numbers continuing to climb. At the same time, the role of the pharmacist in combating the opioid crisis continues to evolve.

Methods

A literature search was conducted in Ovid MEDLINE that incorporated both MeSH terms and keywords to describe two concepts: the opioid epidemic and pharmacists/pharmacies. The search was limited to articles published after 2010 through the end of 2021 and returned 196 articles that were analyzed thematically.

Results

Thematic analysis revealed the following themes: prevention, interventions, public health role of the pharmacist, pharmacists in multiple roles, barriers, pharmacist and healthcare provider attitudes, educational initiatives for pharmacists and student pharmacists, and future research.

Discussion

While a great deal of progress has been made in the role of the pharmacist in supporting individuals with opioid use disorder (OUD) in the last two decades, pharmacists must seek to invest time and resources into practices with a strong evidence base to better mitigate the growing, devastating impact of the opioid crisis. Pharmacists must be willing to embrace new and non-traditional roles in patient care, service and research, and seek to advance evidence-based knowledge and practice.

Conclusion

Pharmacy practice has expanded greatly in the past decade with pharmacists taking on new and creative approaches to addressing the opioid crisis. Collaborative and interdisciplinary approaches to addressing the root causes of opioid misuse and opioid overdose are still desperately needed. These include attention to the critical roles of social determinants of health, stigma elimination, legislative advocacy for patients with OUD, and focused education for providers, pharmacists, and the community. Recognition and support of the value of collaboration to both improve public health and individual patient care, continued investments in pharmacy practice advancement in OUD treatment and harm reduction, and the creation of workflows and prescribing algorithms to assist in dosing medications to prevent withdrawal symptoms and achieve improved pain control are desperately needed.

Contact based intervention reduces stigma among pharmacy students

INTRODUCTION

Interventions to reduce the stigma of substance use disorders by health professionals often include didactic instruction combined with an interactive component that includes a guest speaker in recovery. Few interactive studies have focused on pharmacy students. Community pharmacists are moving to the front lines to battle the opioid epidemic; therefore, pharmacy students should be included in interventions aimed at reducing stigma by health professionals.

METHODS

This study examined the effects of a contact-based interactive intervention delivered by a peer recovery support specialist on perceived stigma of opioid use disorder among third-year pharmacy students (N = 115) enrolled in an integrative psychiatry course. Stigma was measured using the Brief Opioid Stigma Scale.

RESULTS

Our study found significant differences in students' perceived stigma, both with their personal beliefs and their beliefs regarding the public, supporting the use of interactive presentations by peer recovery support specialists to decrease perceived stigma of opioid use disorder by health professionals.

CONCLUSIONS

This type of intervention for pharmacy students shows promise in reducing substance use disorder stigma and should be further explored.

Podcasts as a Method to Deliver Education on Stigma Surrounding Opioid Use Disorder

The objective of this research was to evaluate the effectiveness of a podcast miniseries to reduce stigma surrounding opioid use disorder (OUD) among student pharmacists. Students in their second and third professional years from two schools of pharmacy listened to five, 10-23 min podcasts incorporated into their coursework. The podcasts highlighted: (1) interviews with OUD professionals and those with lived experiences; (2) types of stigma and how it affects health outcomes; (3) OUD disease state processes, and (4) harm reduction strategies. Surveys assessed changes in perception of OUD and its associated stigma and included free-response and Likert scale questions. Subjects (n = 121) who completed a pre- and post-podcast survey were included. Paired t-tests assessed changes in survey responses from baseline and a content analysis was performed on all free-responses. There was a statistically significant change from baseline for each survey question, demonstrating a decrease in stigma towards OUD. Free-responses were categorized into four learning domains: (1) Impact of stigma on access to care; (2) Compassion and empathy; (3) Resources and support; and (4) Call to action. Podcasts can be an effective tool to reduce student pharmacist stigma associated with OUD.

Pharmacy Students' Perceptions and Stigma Surrounding Naloxone Use in Patients with Opioid Use Disorder: A Mixed Methods Evaluation

Pharmacists represent a key group of healthcare professionals that can increase awareness and destigmatize naloxone use. The objective of this study was to investigate pharmacy student perceptions of the use, dispensing, and stigma surrounding naloxone. An electronic survey was administered to pharmacy students that included questions about demographics, work history, naloxone use, and naloxone stigma. Separate qualitative interviews were performed to identify themes surrounding naloxone use. Two-hundred sixty-two participants completed the survey. The majority of participants were “highly willing” (74%) to fill a naloxone prescription for a patient and “somewhat comfortable” (38%) in counseling on naloxone; most were “somewhat comfortable” (38%) administering naloxone. Naloxone is “very rarely” (87%) recommended in community workplace settings, and the majority (64%) reported that patients never request information about naloxone availability. Seventy-six percent of respondents reported that naloxone-associated interactions have an influence on the way they communicate with patients in community pharmacy settings. Thematic analyses found that pharmacy students identify the importance of naloxone as a life-saving medication and the need for naloxone training, but patient-perceived stigma and limited access to naloxone remain prevalent. Pharmacy students are generally well-versed and inclined toward distributing, counseling on, and administering naloxone. Naloxone is rarely dispensed and patient conversations involving naloxone are infrequent in community settings. Future efforts focused on approaches toward difficult patient conversations and normalization of naloxone are needed to destigmatize and facilitate use.