Early Remission of Opioid Use Disorder in an Adolescent Using Buprenorphine Extended - Release Subcutaneous Injection: A Case Report.

Opioid use disorder (OUD) continues to be a major public health crisis, with the current epidemic being driven by synthetic opioids such as illicitly manufactured fentanyl. While medications exist to treat OUD, only sublingual and subdermal buprenorphine formulations are approved for patients aged 16-17 years. Furthermore, almost all pediatric patients who are diagnosed with OUD do not receive medication as treatment. This case describes the innovative use of buprenorphine extended-release subcutaneous injection in a 17-year-old with OUD who has achieved early remission after four months of treatment. This case supports the use of buprenorphine extended-release in pediatric patients who are at high risk. While buprenorphine extended-release injections are not Food and Drug Administration-approved for pediatric patients, the increase in adolescent overdose deaths and lack of access to treatment in this age group support the need for increased research and treatment options for youth with OUD.

Better together: utilizing an interprofessional course and escape room to educate healthcare students about opioid use disorder.

BACKGROUND: The aim of the present study was to determine the impact of an innovative interprofessional educational activity on healthcare professional students' learning. The educational activity targeted student knowledge of opioid use disorder (OUD) and perceptions of working with an interprofessional team while caring for patients with OUD. METHODS: Students from nursing, pharmacy, physician assistant, dentistry, social work, and medicine programs were recruited to participate in the interprofessional educational activity. The educational experience included seven asynchronous modules and a virtual synchronous escape room. Prior to the educational programming, participants completed a pre-survey that assessed their knowledge and attitudes towards working on an interprofessional team and perceptions of patients with OUD. The asynchronous modules were required in order to participate in the escape room and each module contained its own pre/post quiz to assess student knowledge. RESULTS: A total of 402 students participated in the course. Prior to participating in the course, students disagreed that they had extensive educational experience with SUD (2.45 ± 0.79). The students displayed significant improvement in the knowledge based areas after completing the seven asynchronous modules. The largest significant area of knowledge-based improvement was seen in treatment of OUD where on the pre-quiz 65.54 ± 20.21% were answered correctly compared to 95.97 ± 9.61% on the post-quiz. Participation in the escape room significantly changed the students' perceptions of working in interprofessional teams while managing patients with OUD. Of the eleven perception variables assessed, seven showed a significant increase in the post-survey. Following the escape room, participants also strongly agreed that they now would refer patients to colleagues in other disciplines. CONCLUSIONS: An interprofessional educational experience including both an asynchronous course and virtual synchronous escape room can increase participant knowledge around OUD and may improve student perceptions of working with an interprofessional team and caring for patients with OUD.

A Pilot Study of Adolescent and Young Adult Experience with Subcutaneous Depot Medroxyprogesterone Acetate.

STUDY OBJECTIVE: To describe satisfaction with and preference for subcutaneous depot medroxyprogesterone acetate (DMPA-SC), along with adherence and feasibility, in adolescents and young adults (AYAs) METHODS: Survey of a sample of AYA patients who received DMPA-SC prescription and injection RESULTS: Of 108 eligible patients, 34 completed the survey, and 29 respondents received at least 1 DMPA-SC injection. The mean age was 16.9 years. Seventy-nine point three percent used it for gynecologic reasons, 27.6% for gender dysphoria, and 20.7% for contraception (multiple responses allowed); 93.1% were satisfied with DMPA-SC; 78.6% gave DMPA-SC on time; 88.9% reported that giving the injection was easy; 89.7% reported no problems with administration; 89.3% reported no problems obtaining DMPA-SC; and 76.9% plan to continue using DMPA-SC. CONCLUSION: In this small sample of patients within a children's hospital, the overall experience with DMPA-SC was favorable. Clinicians caring for adolescents should consider including DMPA-SC in counseling when depot medroxyprogesterone acetate (DMPA) is indicated.

Pilot Evaluation of Generation Rx Ambassadors Virtual Training to Prepare Students for Medication Safety Outreach.

Objective. To describe the creation of a virtual training program (Generation Rx Ambassadors) and evaluate a pilot offering's impact on knowledge and perceived abilities in delivering medication safety outreach through the Generation Rx program.Methods. Generation Rx (GenRx) is a prevention education program used by student pharmacists to teach safe medication practices in the community. An asynchronous virtual course, called Generation Rx Ambassadors (Ambassadors), was developed to train facilitators on best practices for GenRx delivery. The training was piloted in a mixed student cohort and evaluated using a preprogram/postprogram survey assessing participants' objective knowledge gains and self-perceived abilities to appropriately deliver GenRx education.Results. Fifty-two health sciences undergraduate and graduate students as well as Doctor of Pharmacy (PharmD) students completed the pilot offering of Ambassadors. Regardless of degree status or discipline, participants demonstrated significant knowledge gains for all outcomes except defining medication misuse behaviors (for which there was initial strong mastery). Prior to Ambassadors training, many participants indicated a perceived ability to effectively deliver GenRx education; however, corresponding objective knowledge assessment did not support this belief. Training through the Ambassadors program appropriately aligned participants' perceived abilities with actual content knowledge for most program learning outcomes.Conclusion. These pilot findings suggest that Ambassadors is an effective training tool on best practices for GenRx delivery. More generally, this work reiterates a need to formally train student pharmacists ahead of community outreach activities, particularly in the prevention education arena. Future evaluation will focus on replicating this study with an expanded cohort size and assessing participants' ability to deliver GenRx education in community-based settings.

Medication safety education: more than just a human concern?

The medication misuse epidemic continues to be a major concern for both human and veterinary health-care providers. Medication misuse of veterinary prescribed drugs is contributing to the public health crisis. Education of students regarding appropriate prescribing, communication with clients about medication storage, recognition of signs of vet shopping and animal abuse, and appropriate pain management strategies are essential steps for ensuring our students are prepared for the world that awaits them outside the halls of academic veterinary medicine. This is the moment where veterinarians can make a difference in the lives of patients, students, and the public health.

A team-led remote ambulatory care rotation: Creating efficiency without sacrificing quality.

BACKGROUND AND PURPOSE: Advanced pharmacy practice experiences (APPEs) are a highly anticipated part of the doctor of pharmacy program. Traditionally, these rotations are offered as full-time, onsite experiences. However, there are situations in which geography, transportation, and housing requirements limit the accessibility of these experiences. Additionally, unexpected changes in rotation schedules or resource limitations may leave students in a difficult situation when completing their rotation hours. Having the ability to provide a remote APPE that results in similar student learning outcomes provides flexibility to experiential directors and ensures students' continued progression towards graduation. EDUCATIONAL ACTIVITY AND SETTING: A group of faculty members and post-graduate trainees collaborated to create a remote, one-month ambulatory care experience for 18 students over three months. Students had access to the electronic health record (EHR) from their homes through a partnership with a local federally qualified health center. Access to the EHR enabled the students to participate in telehealth visits and have meaningful interactions with patients as if they were on-site. Students were also able to participate in topic discussions, answer drug information questions, complete a literature evaluation series, and work on projects remotely through this rotation. FINDINGS AND SUMMARY: This remote rotation allowed preceptors to meet the educational needs of students while allowing them to provide patient care through telehealth. Data from summative student evaluations, student evaluations of preceptor and site, and a supplemental survey demonstrate that this remote rotation is a meaningful learning experience for students and is comparable to similar in-person rotations.

Economic impact of pharmacist interventions in pediatric ambulatory care clinics.

OBJECTIVES: Ambulatory care pharmacists have a unique opportunity to identify and prevent adverse drug events (ADEs) throughout a patient's treatment course. These interventions can reduce unexpected clinic visits or hospitalizations, which may lead to decreased health care costs. However, research on this topic has not been conducted in the pediatric population. This study explored the economic impact of pharmacist interventions related to ADEs in pediatric ambulatory care clinics. The primary objective was to determine the total cost avoidance of pharmacist interventions associated with the prevention or management of ADEs in pediatric ambulatory care clinics. The secondary objectives were to describe and quantify pharmacist interventions related to the prevention and management of ADEs in pediatric ambulatory care clinics. METHODS: Pharmacist interventions from pediatric ambulatory care clinics were collected from an electronic health record. These interventions were categorized into 1 of 4 categories: Drug interaction, drug not indicated, prevent or manage ADE, or prevent or manage drug allergy. A review panel consisting of ambulatory care pharmacists reviewed the interventions. The expected probability of the event occurring was classified according to the Nesbit method (0-0.6), and the level of care necessary to treat the potential ADE was determined. The levels of care included hospitalization, ambulatory care, and self-care. The cost avoidance associated with each prevented ADE was calculated by multiplying the probability of the ADE occurring by the average charge of the expected level of care. RESULTS: Of the 8755 interventions documented, 212 were included, leading to a total cost avoidance of $307,210 (range $76,802-$1,071,053). The estimated cost avoidance from each ADE subtype was $128,283 from drug interaction, $20,727 from drug not indicated, $157,993 from prevent or manage ADE, and $207 from prevent or manage drug allergy. CONCLUSION: Pediatric ambulatory care pharmacists optimize health care cost savings through the prevention and management of ADEs as integrated members of the health care team.

Home induction and outpatient treatment of kratom use disorder with buprenorphine-naloxone: A case report in a young adult.

Background: The use of the natural product, kratom, has increased significantly in recent years. The active compounds in kratom have been shown to produce both opioid and stimulant-like effects. While kratom is marketed as a safe, non-addictive method to treat pain and opioid withdrawal, there have been reports demonstrating that kratom is physiologically addictive and linked to overdose deaths. A limited number of case-reports are available describing treatment of kratom use disorder in middle-aged adults, generally in the context of chronic pain and in inpatient settings. Our case is unique in that we describe outpatient treatment of kratom use disorder in a young adult with comorbid attention deficit hyperactivity disorder (ADHD) and in the absence of chronic pain. Case: A 20-year-old college student with ADHD presented to an office-based opioid agonist treatment clinic (OBOT) for treatment of kratom use disorder. He was unable to attend inpatient or residential substance use treatment due to work and school obligations. Additionally, he had stopped taking his prescribed stimulant due to cardiac side effects. The OBOT team successfully initiated buprenorphine-naloxone (BUP/NAL) sublingual films via home induction to treat his kratom use disorder. The patient is being monitored monthly with plans to slowly taper his BUP/NAL dose as tolerated. Discussion: We present a case of a young adult male with kratom use disorder, complicated by a diagnosis of ADHD, successfully treated with BUP/NAL via home induction. The patient is currently kratom-free, reports improved mood and sleep patterns since initiating BUP/NAL, and is able to once again tolerate his ADHD stimulant medication. Healthcare providers should be aware of the use of kratom and consider utilizing BUP/NAL to treat dependence to this botanical drug.

A naloxone and harm reduction educational program across four years of a doctor of pharmacy program.

BACKGROUND AND PURPOSE: Naloxone distribution is an increasing service provided by pharmacists as more states enact laws enabling pharmacists to dispense naloxone without a prescription or per protocol to individuals in the wake of an opioid overdose epidemic. Education and training programs are necessary to ensure students and practicing pharmacists are able to effectively provide the service. EDUCATIONAL ACTIVITY AND SETTING: All first, second, and third year students in the doctor of pharmacy (PharmD) program at The Ohio State University College of Pharmacy (OSUCOP) participated in a pilot naloxone and harm reduction educational program. The program consisted of a three-part recorded lecture and a hands-on interactive workshop. Fourth-year students had the opportunity to participate. Students completed a ten-question assessment based on the content of the recorded lecture. Following the workshop, self-reflection and feedback were solicited. FINDINGS: Qualitative data indicated students felt the naloxone educational program was beneficial. Inclusion of harm reduction strategies, a mock counseling session, hands-on practice with naloxone delivery devices, and patient case discussions were valued. DISCUSSION AND SUMMARY: OSUCOP was able to develop and deliver a naloxone and harm reduction educational program across all four years of the PharmD curriculum within one year of passage of laws increasing pharmacist dispensing of naloxone.