Fact vs. fiction: naloxone in the treatment of opioid-induced respiratory depression in the current era of synthetic opioids.

Opioid-induced respiratory depression (OIRD) deaths are ~80,000 a year in the US and are a major public health issue. Approximately 90% of fatal opioid-related deaths are due to synthetic opioids such as fentanyl, most of which is illicitly manufactured and distributed either on its own or as an adulterant to other drugs of abuse such as cocaine or methamphetamine. Other potent opioids such as nitazenes are also increasingly present in the illicit drug supply, and xylazine, a veterinary tranquilizer, is a prevalent additive to opioids and other drugs of abuse. Naloxone is the main treatment used to reverse OIRD and is available as nasal sprays, prefilled naloxone injection devices, and generic naloxone for injection. An overdose needs to be treated as soon as possible to avoid death, and synthetic opioids such as fentanyl are up to 50 times more potent than heroin, so the availability of new, higher-dose, 5-mg prefilled injection or 8-mg intranasal spray naloxone preparations are important additions for emergency treatment of OIRDs, especially by lay people in the community. Higher naloxone doses are expected to reverse a synthetic overdose more rapidly and the current formulations are ideal for use by untrained lay people in the community. There are potential concerns about severe withdrawal symptoms, or pulmonary edema from treatment with high-dose naloxone. However, from the perspective of first responders, the balance of risks would point to administration of naloxone at the dose required to combat the overdose where the risk of death is very high. The presence of xylazines as an adulterant complicates the treatment of OIRDs, as naloxone is probably ineffective, although it will reverse the respiratory depression due to the opioid. For these patients, hospitalization is particularly vital. Education about the benefits of naloxone remains important not only in informing people about how to treat emergency OIRDs but also how to obtain naloxone. A call to emergency services is also essential after administering naloxone because, although the patient may revive, they may overdose again later because of the short half-life of naloxone and the long-lasting potency of fentanyl and its analogs.

Evaluation of long term retention and utilization of the situation, background, assessment, recommendation (SBAR) communication technique.

INTRODUCTION: Effective communication as part of an interprofessional team is a required standard of pharmacy education. The Situation, Background, Assessment, Recommendation (SBAR) communication technique is an evidence-based method shown to improve patient safety, and is embedded in some curricula of pharmacy and other health care professions. The aim of this study is to determine whether students can utilize the SBAR communication technique during an interprofessional skills assessment one year following initial instruction. METHODS: Students are initially trained on the SBAR technique in an interprofessional setting using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) method in the fall of the second professional year. One year later, students participated in a simulated interaction with a physician as part of the pulmonary module of the pharmacotherapeutics series. Faculty evaluators noted how many and which components of the SBAR technique students used during the interaction. The simulation was run for two academic years, results of which were compared. RESULTS: There was a significant difference in the number of students who used all four components of SBAR. A significant difference also existed between the use of the "situation" and "background" components. CONCLUSION: The TeamSTEPPS method appears to be an effective method to train students on the SBAR communication technique and results in long term retention. Pharmacy programs should consider the use of the TeamSTEPPS method early in their curricula.

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.

A novel naloxone training compared with current recommended training in an overdose simulation.

OBJECTIVES: The aim of this study was to determine if a novel naloxone training program with a focus on situational stress management yields better results than the currently recommended state training in a simulated overdose response. METHODS: Students were randomized to receive either the state training or a novel training developed by the Wilkes University Nesbitt School of Pharmacy. After their respective training, each student individually completed a live simulated overdose response with an added stressor of a panicked bystander. A checklist was used to evaluate students during the simulation, and the results were compared. RESULTS: The average grade for the novel training students was 89% compared with 64% for the state training students (P < 0.001). There was no statistically significant difference in time to complete the simulation. CONCLUSION: Students who underwent the novel training received the state training. The novel training appears to be effective in preparing students to manage a live opioid overdose.

Impact of an innovative pain elective course on student beliefs and attitudes towards opioid medication use.

BACKGROUND AND PURPOSE: To determine if an innovative elective course in chronic pain management focused on a multimodal treatment approach changed student views on opioid use for chronic, non-cancer pain. EDUCATIONAL ACTIVITY AND SETTING: Offered to students in the second and third professional year, the course focused on various aspects of the treatment and impact of pain. Students completed two major, self-directed projects as well as four reflection journals throughout the semester. A nine question survey was provided to students on the first and last day of class that identified their beliefs and attitudes towards opioid use in chronic non-cancer pain using a five point Likert scale. FINDINGS: There was a statistical difference in one question asking if long acting opioids were effective in controlling pain long term. SUMMARY: There was evidence of change in student perceptions. Similar self-directed courses should be considered by other institutions as a means to change student beliefs and attitudes.

Using a community theatre as a self-directed introductory pharmacy practice experience (SD IPPE) site.

OBJECTIVE: To describe a novel setting and method for self-directed introductory pharmacy practice experiences (SD IPPE). METHODS: Students presented health care information relative to the plot of a production at a local community theater throughout the season. Students developed a poster and handout that were presented in the theater lobby prior to each production. ASSESSMENT: A six-question survey was provided to students after each presentation that identified their perceived benefit to play patrons and their overall experience using a 5-point Likert scale. IMPLICATIONS: Completing SD IPPE in a theater is a novel and innovative concept. Data suggest that students prefer presenting information in non-traditional settings. Students felt their work enhanced the theatrical experience of patrons. Results demonstrate that the theater is a viable setting for future presentations that benefit both students and public.