Motives for nonmedical use of prescription stimulants in community college students.

Objective: The present study identified common motives for nonmedical use of prescription stimulants (NMUS) among community college (CC) students and examined behavioral and demographic correlates of certain motives. Participants: The survey was completed by 3,113 CC students (72.4% female; 81.7% White). Methods: Survey results from 10 CCs were evaluated. Results: NMUS was reported by 9% (n = 269) participants. The most common motive for NMUS was to "focus on studies or to improve academic performance" (67.5%) followed by to "have more energy" (52.4%). Females were more likely to report NMUS for weight loss, and males were more likely to report NMUS to experiment. The motive "to feel good or get high" was linked to polysubstance use. Conclusions: CC students report similar motives for NMUS to those commonly endorsed by 4-year university students. These findings may help identify CC students susceptible to risky substance use.

Primary care physicians' opioid-related prevention behaviors and intentions: A descriptive analysis.

OBJECTIVE: Primary care physicians (PCPs) are positioned to mitigate opioid morbidity and mortality, but their engagement in primary, secondary, and tertiary opioid-related prevention behaviors is unclear. The objective of this study was to evaluate Tennessee PCPs' engagement in and intention to engage in multiple opioid-related prevention behaviors. METHODS: A survey instrument was developed, pretested, and pilot tested with practicing PCPs. Thereafter, a census of eligible Tennessee PCPs was conducted using a modified, four-wave tailored design method approach. Three patient scenarios were employed to assess physician intention to engage in 10 primary, secondary, and tertiary prevention behaviors. Respondents were asked to report, given 10 similar scenarios, the number of times (0-10) they would engage in prevention behaviors. Descriptive statistics were calculated using SPSS version 25. RESULTS: A total of 296 usable responses were received. Physician intention to engage in prevention behaviors varied across the 10 behaviors studied. Physicians reported frequently communicating risks associated with prescription opioids to patients (8.9 ± 2.8 out of 10 patients), infrequently utilizing brief questionnaires to assess for risk of opioid misuse (1.7 ± 3.3 out of 10 patients), and screening for current opioid misuse (3.1 ± 4.3 out of 10 patients). Physicians reported seldomly co-prescribing naloxone for overdose reversal and frequently discharging from practice patients presenting with an opioid use disorder. CONCLUSIONS: This study noted strengths and opportunities to increase engagement in prevention behaviors. Understanding PCPs' engagement in opioid-related prevention behaviors is important to effectively target and implement morbidity and mortality reducing interventions.

The Impact of Transitions Related to COVID-19 on Pharmacy Student Well-being.

Objective. To characterize the impact of COVID-19 transitions on first professional year (P1) students' domain-specific and overall well-being.Methods. All P1 students (N=74) enrolled at one college of pharmacy self-reported their career, community, financial, physical, social, and overall well-being on a weekly basis from January 6 through April 27, 2020. Parametric statistical tests and effect sizes were used to compare well-being scores pre-transition and post-transition and to compare well-being scores to a previous cohort of P1 students.Results. Mean well-being scores decreased when comparing pre-transition vs post-transition scores, with effect sizes ranging from dav=.16 for financial well-being to dav=.84 for social well-being. The average percent of students that reported struggling increased by 86.1% (16.8% vs 31.2%) post-transition, and the average percent of students that reported suffering post-transition was 351% higher (1.3% vs 6%) than pre-transition.Conclusion. Pharmacy students' domain specific and overall well-being significantly decreased with COVID-19-related transitions. The percentage of students reporting struggling or suffering significantly increased post-transition.

Pharmacists' nonprescription syringe dispensing perceptions and behaviors: A three-state descriptive analysis.

BACKGROUND: One approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists' nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. METHODS: We conducted a telephone census of community pharmacies in the Appalachian counties of North Carolina, Tennessee, and Virginia from April-June 2018. Behaviors studied included having ever sold syringes without a prescription, quantity of individuals to whom nonprescription syringes were dispensed in the past 30 days, having ever denied a request for nonprescription syringes, and past 30-day denial of nonprescription syringe requests. Behavioral intention and perceptions of legality were elicited. RESULTS: A response rate of 52.3 % was achieved (N = 391). North Carolina pharmacists reported increased past 30-day dispensing, less denial of nonprescription syringe requests, and decreased justification for syringe dispensing (proof of medical need) as compared to Tennessee and Virginia pharmacists. Behavioral intention to dispense did not vary by state but did vary by political affiliation. Perceptions of syringe dispensing legality in NC were significantly different from those in TN and VA. CONCLUSIONS: Significant differences in pharmacists' perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.

An analysis of pharmacists' workplace patient safety perceptions across practice setting and role characteristics.

Background: Lay press investigations have been published that describe pharmacist errors and the workplace environment in the community pharmacy setting. However, recent studies that explore pharmacists' perceptions of patient safety in the workplace are limited. Objectives: 1) To describe pharmacists' perceptions of workplace patient safety; 2) To compare pharmacists' perceptions of workplace patient safety across practice setting type, pharmacist roles, average hours worked per shift, and average hours worked per week. Methods: Actively licensed Tennessee pharmacists were recruited from January 1 and June 30, 2019 to complete a 13-item survey of workplace patient safety perceptions ( N =1391). Descriptive statistics were calculated, and nonparametric statistical tests employed to compare differences in perceptions across practice setting type, pharmacist roles, and hours worked per shift and per week. Results: Statistically significant differences in workplace patient safety perceptions were noted across practice setting type (p values <.001) and pharmacist roles (p values <.001). The extent to which pharmacists agreed/strongly agreed that their employer provides a work environment that allows for safe patient care ranged from 29.7% of chain community pharmacists to 85% of compounding pharmacists. Fifty-two percent of staff pharmacists, 56.5% of relief pharmacists, and 58.5% of managers/pharmacists in charge agreed or strongly agreed that their employer provides a work environment that allows for safe patient care, whereas 89.3% of regional managers/directors/vice-presidents and 72.5% of clinical/specialty pharmacists indicated the same. Average hours per shift was inversely correlated with perceptions of workplace patient safety (p values <.001). Conclusion: Tennessee pharmacists' perceptions of workplace patient safety varied widely across practice setting type and pharmacist roles. Perceptions of safety were notably lower in the chain community pharmacy setting. Additional research is warranted to better understand the relationship between pharmacist perceptions and quantifiable patient safety metrics, particularly in the chain community pharmacy setting.

A Longitudinal Analysis of First Professional Year Pharmacy Student Well-being.

Objective. To assess and characterize Doctor of Pharmacy (PharmD) students' well-being across the first professional year (P1) and determine the relationship between the number of examinations taken, student grade point average, and well-being scores. Methods. All P1 students (N=76) enrolled at one college of pharmacy self-reported their career, community, financial, physical, social, and overall well-being on a weekly basis during the fall and spring semesters. Parametric statistical tests were used to examine the extent to which students' well-being scores varied throughout the academic year, the extent to which their domain-specific well-being scores predicted overall well-being scores, and the association between their well-being scores and the number of examinations they had taken in a week and their grade point average. Results. Overall and domain-specific well-being scores significantly decreased from the beginning to the end of fall semester. Students' overall well-being across the academic year was most frequently predicted by their career well-being, physical well-being, and social well-being scores. Career, community, physical, and overall well-being scores were significantly negatively associated with the number of examinations the students completed during the week. Students' self-reported overall well-being during the fall semester was positively associated with their fall semester GPA. Conclusion. Significant variation was found in students' domain-specific and overall well-being across the P1 year. These findings can guide both the development and timing of school interventions to promote student well-being.

Community pharmacist engagement in opioid use disorder prevention and treatment behaviors: A descriptive analysis.

OBJECTIVES: This study describes community pharmacists' opioid analgesic and medication for opioid use disorder (MOUD) practice behaviors and behavioral intentions in the context of primary, secondary, and tertiary prevention of opioid use disorder (OUD). METHODS: The study sampling frame consisted of 2302 Tennessee community-practice pharmacists who were asked to complete a mailed, paper questionnaire. Behavioral intentions were elicited by asking pharmacists to indicate the number of times (0 to 10) they engage in a behavior, given 10 patients in 3 distinct vignettes. Perceptions of evidence-based MOUD and pain management patient care practices were also elicited. RESULTS: A response rate of 19.7% was achieved. Pharmacists reported using a brief questionnaire to evaluate risk of opioid misuse with 2.1 ± 3.7 (mean ± SD) out of 10 patients, screening 2.1 ± 3.7 patients for current opioid misuse, discussing co-dispensing of naloxone with 2.9 ± 3.4 to 3.3 ± 4 out of 10 patients at a risk of overdose, and dispensing buprenorphine/naloxone to a mean of 4.6 ± 4.2 patients when they presented a prescription. Respondents perceived 38% of pain management and 30% of MOUD prescribers in their area to practice evidenced-based care. CONCLUSION: Pharmacists have an opportunity to improve the outcomes for patients prescribed opioids by increasing engagement across OUD prevention levels.

Communication Experiences of DATA-Waivered Physicians with Community Pharmacists: A Qualitative Study.

Background: Patients engaged in evidence-based opioid use disorder (OUD) treatment can obtain prescriptions for buprenorphine containing products from specially trained physicians that are subsequently dispensed by community pharmacists. Despite the involvement of physicians and community pharmacists in buprenorphine prescribing and dispensing, respectively, our understanding of their interactions in this context is limited. Objective: To qualitatively describe the communication and collaborative experiences between Drug Addiction Treatment Act 2000 (DATA)-waivered physicians and community pharmacists from the perspective of the physician. Methods: Ten key informant interviews were conducted with DATA-waivered physicians practicing in Northeast Tennessee. A semi-structured interview guide was used to explore communication and collaborative experiences between the physicians and community pharmacists. Interviews were audio recorded and transcribed verbatim. A coding frame was developed using concepts from the scientific literature and emerging codes from physician interviews. Interviews were coded using NVivo 11, with the data subsequently organized and evaluated for themes. Results: Four themes were identified: (1) mechanics of communication; (2) role specification and expectations; (3) education and understanding; and (4) climate of clinical practice. Physician-pharmacist communication primarily occurred indirectly through patients or staff and perceived challenges to collaboration included; lack of trust, stigma, and fear of regulatory oversight. Physicians also indicated the two professionals may lack clear roles and responsibilities as well as common expectations for treatment plans. Conclusions: Communication between DATA-waivered physicians and community pharmacists is influenced by multiple factors. Further research is warranted to improve physician-community pharmacist collaboration (PCPC) in the context of OUD pharmacotherapy and addiction treatment.

Explaining Pharmacy Students' Dispensing Intentions in Substance Abuse-Related Gray Areas Using the Theory of Planned Behavior.

Objective. To examine the extent to which theory of planned behavior (TPB) constructs and demographic characteristics explain pharmacy students' dispensing intentions in ethically or legally gray areas involving potential substance misuse or abuse. Methods. Two cohorts of third-year Doctor of Pharmacy (PharmD) students (n=159) were provided with five written cases describing common "gray area" dispensing scenarios in community practice involving medications and devices with potential for misuse or abuse (eg, long-term buprenorphine maintenance prescription without evidence of tapering, early refill of a narcotic for an out-of-town patient, non-prescription sale of pseudoephedrine). Students completed a 12-item survey instrument for each case. Items assessed whether the student would dispense the medication or device in the given scenario, how many times in 10 similar scenarios the student would dispense the medication or device, attitudes regarding dispensing, and subjective norm and perceived behavioral control beliefs. Results. Wide variation in the percentages of students who would dispense the medications or devices was noted across the five scenarios (14% in the buprenorphine scenario to 61% in the pseudoephedrine scenario). Attitude scores significantly predicted dispensing decisions in all scenarios (p<.001), whereas subjective norm and perceived behavioral control beliefs were significant predictors of dispensing only in select case scenarios. Gender and community pharmacy work experience did not consistently predict dispensing intentions. Conclusion. Student attitudes consistently predicted intent to dispense across five gray practice scenarios. These findings can be used to inform development of educational interventions that influence students' attitudes and self-awareness in community practice decision-making scenarios involving potential substance misuse or abuse.

Student Pharmacists' Personal Finance Perceptions, Projected Indebtedness Upon Graduation, and Career Decision-making.

Objective. To evaluate the extent to which Doctor of Pharmacy students' personal finance perceptions, projected student loan indebtedness, and demographic characteristics predict postgraduation career intentions. Methods. Students at three pharmacy colleges completed a 31-item survey instrument that assessed personal finance perceptions, self-efficacy beliefs, anticipated student loan debt upon graduation, postgraduate intentions, anticipated practice setting upon graduation, and demographic characteristics. Logistic regression models were used to examine the extent to which personal finance perceptions, student loan indebtedness, and demographic characteristics predicted postgraduate intentions and anticipated practice setting. Results. There were 763 usable responses obtained (response rate=90.3%). Students reported an anticipated personal student loan debt at graduation of $162,747 (SD=$87,093) and an estimated 7.4 (SD=5.8) years to pay off non-mortgage debt postgraduation. Fifty-three percent of students reported planning to practice in a community pharmacy setting postgraduation, and 54% indicated they intended to enter practice directly. Student loan indebtedness was not a significant predictor of whether students planned to pursue postgraduate training. There was a significant association between debt influence and pressure perceptions and students' plans to pursue postgraduate training (aOR=0.78; 95% CI=0.65-0.94). The odds of indicating hospital (vs chain community) pharmacy as the anticipated setting decreased 36% with every one point increase in debt influence and pressure perceptions (aOR=0.64; 95% CI=0.50-0.81). Conclusion. Pharmacy students' perceived debt pressure and influence predicted their intention to enter practice directly (vs pursuing postgraduate training) and to select a career in chain community pharmacy (vs hospital pharmacy). Student loan indebtedness was not a significant predictor of postgraduate training intentions. These findings suggest that interventions that equip students to manage the pressure associated with large student loan debts should be explored.

Revisiting Faculty Citizenship.

This commentary describes the significance of faculty citizenship in the broader context of institutional culture and defines faculty citizenship for use across all aspects of faculty roles in the Academy. The definition includes two key components (engagement and collegiality) that can be used to measure citizenship behaviors. Continued discussion and study of faculty citizenship will further the Academy's understanding and use of the concept.

Leading Change in Academic Pharmacy: Report of the 2018-2019 AACP Academic Affairs Committee.

EXECUTIVE SUMMARYThe Committee was charged with the responsibility for examining the need for change in pharmacy education and the models of leadership that would enable that change to occur across the academy. They also examined the question of faculty wellbeing in a time of change and made several recommendations and suggestions regarding both charges. Building upon the work of the previous Academic Affairs Committee, the 2018-19 AAC encourages the academy to implement new curricular models supporting personalized learning that creates engaged and lifelong learners. This will require transformational leadership and substantial investments in faculty development and new assessment strategies and resources. Recognizing that the magnitude of the recommended change will produce new stress on faculty, the committee identified the need for much additional work on student, faculty and leaders' wellbeing, noting the limited amount of empirical evidence on pharmacy related to stress and resilience. That said, if faculty and administrators are not able to address personal and community wellbeing, their ability to support their students' wellbeing will be compromised.

Breaking Down Barriers to Pharmacy Graduate Education: The Report of the 2017-2018 Research and Graduate Affairs Committee.

EXECUTIVE SUMMARY The 2017-2018 Research and Graduate Affairs Committee (RGAC) was given three charges aimed at helping academic pharmacy address barriers that must be overcome by both students and schools to attract, retain, and support the development of a diverse, well-rounded, and successful graduate student population. These charges were (1) identifying teaching methodologies, tools and opportunities that graduate programs can introduce into curriculum to overcome barriers to success of today's and tomorrow's learners; (2) developing a strategy for achieving member support of the 2016-2017 recommended graduate competencies by identifying gaps in and existing examples of courses or opportunities that achieve competency-based pharmacy graduate education; and (3) identifying potential strategies to address identified barriers to pursuing graduate education, especially among under-represented student populations. This report describes attitudes toward and opportunities related to competency-based education in graduation education in colleges and schools of pharmacy, identifies types of tools schools could use to enhance training towards the competency framework developed by the 2016-2017 RGAC, particularly with regards to the so-called power skills, and outlines a role for AACP in facilitating this training. This report also considers a number of barriers, both perceived and real, that potential students encounter when considering graduate training and suggests strategies to understand the impact of and mitigate these barriers. To strengthen competency-based graduate education, the RGAC puts forth two recommendations that AACP develop a toolkit supporting the training of power skills and that AACP should develop or curate programs or tools to support the use of individual development plans (IDPs). The RGAC also puts forth a suggestion to schools that IDPs be implemented for all students. In considering the barriers to pursuing graduate education, the Committee proposes one policy statement that AACP supports the training and development of an increasingly diverse population of researchers at pharmacy schools through active efforts to promote M.S. and Ph.D. education along with Pharm.D. education. Additionally, the Committee provides recommendations that AACP should expand its efforts in career tracking of graduate students to include collection and/or analysis of data that could inform the Academy's understanding of barriers to pursuing graduate education in pharmacy schools, the AACP Office of Institutional Research and Effectiveness should expand upon graduate program data described in the annual Profile of Pharmacy Students report, and finally that AACP should include graduate programs in efforts to increase diversity of students at pharmacy schools.

Introduction to the opioid epidemic: the economic burden on the healthcare system and impact on quality of life.

Opioid analgesics are commonly used to treat acute and chronic pain; in 2016 alone, more than 60 million patients had at least 1 prescription for opioid analgesics filled or refilled. Despite the ubiquitous use of these agents, the effectiveness of long-term use of opioids for chronic noncancer pain management is questionable, yet links among long-term use, addiction, and overdose deaths are well established. Because of overprescribing and misuse, an opioid epidemic has developed in the United States. The health and economic burdens of opioid abuse on individuals, their families, and society are substantial. Part 1 of this supplement will provide a background on the burden of pain and the impact of opioid abuse on individuals, their families, and society; the attempts to remedy this burden through prescription opioid use; and the eventual downward spiral into the current opioid epidemic, including an overview of opioid analgesics and opioid use disorder and the rise in opioid-related deaths.

Abuse-Deterrent Opioid Formulations: A Key Ingredient in the Recipe to Prevent Opioid Disasters?

The US Food and Drug Administration (FDA) is encouraging the innovation of long-acting opioid formulations that are manipulation-resistant. The purpose of this commentary is to assess the benefits and limitations of abuse-deterrent opioid formulations (ADFs) and discuss their role in mitigating the current opioid epidemic. ADFs have been created with chemical properties that make it difficult for people who non-medically use prescription drugs to crush and dissolve opioid tablets, as well as by combining opioids with antagonists such as naloxone or naltrexone, which are released only when the dosage form has been manipulated or the drug is taken by a non-intended route. Despite these and other technologies, consensus regarding the effectiveness of these formulations in preventing non-medical use is lacking given the difficulty in obtaining post-marketing data. Researchers also question if the creation of abuse-deterrent drugs will have a positive effect on those struggling with a severe opioid-use disorder, fearing that current opioid users will simply find a new - perhaps more dangerous - drug of choice. Abuse-deterrent opioids are still opioids, and although they may make manipulation more difficult than non-ADF formulations, they are not "abuse proof." The introduction of ADFs could provide a false sense of security among prescribers and dispensers, and we fear that ADFs may have a minimal impact on non-medical use of prescription opioids. Further epidemiological studies will be required to determine the large-scale impact of abuse-deterrent opioids in preventing opioid use disorder and its downstream consequences.

Interprofessional prescription opioid abuse communication among prescribers and pharmacists: A qualitative analysis.

BACKGROUND: Prescribers and community pharmacists commonly perceive prescription opioid abuse to be a problem in their practice settings and communities. Both cohorts have expressed support for interventions that improve interprofessional communication and reduce prescription opioid abuse. The objective of this study was to describe prescription opioid abuse-related communication among and between prescribers and community pharmacists in South Central Appalachia. METHODS: The investigators conducted five focus groups with 35 Appalachian Research Network practice-based research network providers between February and October, 2014. Two prescriber-specific, two pharmacist-specific, and one interprofessional (prescribers and pharmacists) focus groups were conducted, recorded, and transcribed. Data collection and analysis occurred iteratively. Emerging themes were inductively derived and refined. Five member-checking interviews were conducted to validate themes. RESULTS: Providers noted several factors that influence intraprofessional and interprofessional communication, including level of trust, role perceptions, conflict history and avoidance, personal relationships, and prescription monitoring program use. Indirect communication approaches via patients, office staff, and voicemail systems were common. Direct pharmacist to prescriber and prescriber to pharmacist communication was described as rare and often perceived to be ineffective. Prescriber to pharmacist communication was reported by prescribers to have decreased after implementation of state prescription monitoring programs. Difficult or uncomfortable conversations were often avoided by providers. CONCLUSIONS: Interprofessional and intraprofessional prescription opioid abuse communication is situational and influenced by multiple factors. Indirect communication and communication avoidance are common. Themes identified in this study can inform development of interventions that improve providers' intra- and interprofessional communication skills.

Pharmacists' and prescribers' neonatal abstinence syndrome (NAS) prevention behaviors: a preliminary analysis.

Background Maternal opioid use and neonatal abstinence syndrome (NAS) incidence have increased markedly in the US in recent years. Objectives (1) To assess prescribers' and community pharmacists' guideline-based NAS prevention behaviors; (2) to describe providers' perceptions of contraceptive appropriateness in female patients of childbearing age. Method Cross-sectional study of 100 randomly selected primary care physicians, 100 prescribers authorized to engage in in-office treatment of opioid use disorders with buprenorphine, 100 pain management clinic directors, and 100 community pharmacists in Tennessee (N = 400 providers total) to evaluate self-reported engagement in 15 NAS prevention behaviors and perceived appropriateness of 8 contraceptive methods in opioid using women of childbearing age. Results An overall response rate of 17.5% was obtained. Pain clinic directors reported the most engagement in NAS prevention, engaging 80% or more of female patients of childbearing age prescribed an opioid in 11 prevention behaviors, followed by buprenorphine prescribers (8 behaviors), primary care physicians (5 behaviors), and community pharmacists (2 behaviors). Pain clinic directors, primary care physicians, and community pharmacists perceived oral contraceptive pills and patches to be as appropriate as long-acting, reversible forms of contraception (e.g., implants, injectable depots, intrauterine devices). Conclusion Provider engagement in behaviors that could prevent NAS is variable. Interventions should be implemented that equip providers to engage patients in conversations about long-acting, reversible contraception.

Assessing Faculty and Student Interpretations of AACP Survey Items with Cognitive Interviewing.

Objective. To use cognitive interviewing techniques to determine faculty and student interpretation of a subset of items from the AACP faculty and graduating student surveys. Methods. Students and faculty were interviewed individually in a private room. The interviewer asked each respondent for his/her interpretation of 15 randomly selected items from the graduating student survey or 20 items from the faculty survey. Results. While many items were interpreted consistently by respondents, the researchers identified several items that were either difficult to interpret or produced differing interpretations. Conclusion. Several interpretational inconsistencies and ambiguities were discovered that could compromise the usefulness of certain survey items.

Teaching Communication Skills to Medical and Pharmacy Students Through a Blended Learning Course.

Objective. To evaluate the impact of an interprofessional blended learning course on medical and pharmacy students' patient-centered interpersonal communication skills and to compare precourse and postcourse communication skills across first-year medical and second-year pharmacy student cohorts. Methods. Students completed ten 1-hour online modules and participated in five 3-hour group sessions over one semester. Objective structured clinical examinations (OSCEs) were administered before and after the course and were evaluated using the validated Common Ground Instrument. Nonparametric statistical tests were used to examine pre/postcourse domain scores within and across professions. Results. Performance in all communication skill domains increased significantly for all students. No additional significant pre/postcourse differences were noted across disciplines. Conclusion. Students' patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied similarly between medical and pharmacy students postcourse, suggesting both groups respond well to this form of instruction.