Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy.

In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

Student Performance Outcomes and Perceptions in Two Content Areas in Conventional Versus Integrated Pharmacy Curricula.

Objective. To compare student performance measures and perceptions of learning in 2 content areas, conventional and integrated pharmacy curricula, at a single institution.Methods. Prospective cohort study of pharmacy students enrolled in either conventional (cohort C) or integrated (cohort I) curricula. Summative examination performance in the neuropsychiatric and infectious diseases courses, student self-rating of confidence and comfort in integrating and applying knowledge, and performance on a delayed knowledge assessment were compared between cohorts.Results. Cohort I students performed significantly lower on summative assessments compared to cohort C (78.4±9.1 vs 84.5±8.3, respectively). Prior to the integrated course, cohort I students rated themselves as significantly less confident and comfortable in knowledge integration, application, and communication compared to cohort C students; these differences were attenuated in a follow-up survey, although some remained significant. There was no difference between cohorts in performance on objective structured clinical examinations (OSCEs) or on a delayed knowledge assessment of neuropsychiatric and infectious diseases content.Conclusion. Pharmacy students in an integrated curriculum initially performed modestly worse in summative assessments and self-assessed their baseline knowledge as lower than did students in a conventional curriculum. However, differences in self-rated knowledge decreased at follow-up, and performance of the two cohorts on OSCEs and a delayed examination was similar. As pharmacy curricula shift towards integrated models, institutions should also consider evaluating experiential performance outcomes and student motivation to fully assess the impact of these transitions.

Impact of an auditory hallucination simulation coupled with a speaker diagnosed with schizophrenia on mental illness stigma in pharmacy students.

INTRODUCTION: Hallucination simulations improve student empathy but increase desired social distance from individuals with schizophrenia, while direct contact reduces social distance. This study describes the implementation of combining an auditory hallucination simulation with a speaker diagnosed with schizophrenia and its impact on mental illness stigma. METHODS: Pharmacy students in their last year of didactic instruction (N = 346) attended a presentation by a speaker diagnosed with schizophrenia then participated in a hallucination simulation. Mental illness stigma was measured before and after the intervention using the Opening Minds Survey for Health Care Professionals (OMS-HC). Related-samples Wilcoxon-signed rank tests were used to evaluate changes in OMS-HC scores. An inductive qualitative analysis was conducted on student perceptions of patients with psychosis. RESULTS: OMS-HC total scores were reduced by an average of 2.0 ± 5.6 (P = .005) for the first-year pilot and 2.3 ± 7.0 (P < .001) for the subsequent year. OMS-HC attitudes (P = .005) and disclosure/help-seeking (P < .005) subscales decreased both years. There was no significant change in the social distance subscale (P = .205) the first year and a significant decrease (P = .015) the second year. The themes identified from the open-ended comments were increased awareness, sympathy, empathy, inspiration/admiration, discomfort, and change to patient care. CONCLUSIONS: The combination of a speaker with schizophrenia and auditory hallucination simulation effectively reduced mental illness stigma. The combination is likely effective for reducing stigmatizing attitudes and willingness to disclose mental illness with variable reduction in desired social distance.

Characterizing Participant Perceptions about Smoking-Cessation Pharmacotherapy and E-Cigarettes from Facebook Smoking-Cessation Support Groups.

The prevalence of smoking among young adults aged 19-28 years old in the United States persists at rates of 14.3%. Young adults underutilize pharmacotherapy for smoking cessation, and the use of e-cigarettes has increased. We analyzed comments from online smoking-cessation support groups to understand young-adult smokers' views of pharmacotherapy and e-cigarettes, to provide a more in-depth insight into the underutilization of pharmacotherapy. A qualitative analysis was performed on comments about pharmacotherapy and e-cigarettes from participants enrolled in online smoking-cessation support groups in 2016-2020. A codebook was developed with a deductive approach to code the comments, followed by thematic analysis. Eighteen themes were identified, with four dominant themes: interest, benefit, knowledge, and flavor. Participants expressed less interest in both nicotine-replacement therapy and e-cigarettes; moreover, they expressed unfamiliarity with and misconceptions about pharmacotherapy, and recognized the enticing flavors of e-cigarettes. Participants often felt e-cigarettes were not useful for smoking cessation, but the flavors of e-cigarettes were appealing for use. Participants had mixed opinions about the use of e-cigarettes for smoking cessation, but predominantly felt e-cigarettes were not useful for smoking cessation. The use of social media may be an effective way to address misconceptions about pharmacotherapy for smoking cessation and increase willingness to accept assistance.

Implementation and Evaluation of a 10-Week Health Equity Curriculum for Pharmacy Students.

Objective To describe a health equity curriculum created for pharmacy students and evaluate students' perceptions and structural competency after completion of the curriculum.Methods A health equity curriculum based on transformative learning and structural competency frameworks was implemented as a 10-week mandatory component of the pass-no pass neuropsychiatric theme for second year pharmacy students. Each week, students reviewed materials around a neuropsychiatric-related health equity topic and responded to discussion prompts through asynchronous forums or synchronous online video discussions. The effectiveness of the health equity curriculum was evaluated through assessment of structural competency through a validated instrument, an objective structured clinical examination (OSCE), and a questionnaire.Results All enrolled second year pharmacy students (n=124) participated in the health equity curriculum. Of the 75 students who completed the structural competency instrument, 46 (61%) were able to identify structural determinants of health, explain how structures contribute to health disparities, or design structural interventions. Ninety-six of the 124 students (77%) were able to address their OSCE standardized patient's mistrust in the health care system. Thematic analysis of student comments elucidated three themes: allyship, peer connection, and self-awareness. Students rated asynchronous discussion forums as significantly less effective than online video discussions and patient cases for achieving curricular objectives.Conclusion A mandatory curriculum delivered remotely throughout the didactic pharmacy curriculum using a blended learning approach was an effective way to incorporate health equity content and conversations into existing courses. Implementation of this or similar curriculums could be an important step in training pharmacy students to be advocates for social justice.

Impact of a psychiatry elective on mental health stigma among pharmacy students.

BACKGROUND AND PURPOSE: Mental health stigma among healthcare providers remains a significant barrier to patients receiving optimal care for psychiatric conditions. This study's purpose is to evaluate the impact of a psychiatry elective on pharmacy students' attitudes toward patients with mental health disorders. EDUCATIONAL ACTIVITY AND SETTING: This study cohort included pharmacy students enrolled in a Special Topics in Psychiatry elective. Attitudes toward mental health disorders were measured at baseline (first day of class) and post-exposure (last day of class) using the 21-item Beliefs toward Mental Illness (BMI) Scale. Wilcoxon signed-rank tests were used to compare each component of the BMI scale as well as each subscale (dangerousness, poor social and interpersonal skills, and incurability) at baseline and post-exposure. FINDINGS: Fifty-eight pharmacy students (68% response rate) participated in this study. Most respondents were in their first year of the pharmacy program (44%), female (72%), and Asian (59%). There was a statistically significant decline in each BMI subscale at the end of the course: dangerousness, poor interpersonal and social skills, and incurability. There was no significant difference in mean change for the BMI sub-scores by gender, race, or personal experience with mental health disorders. SUMMARY: Incorporating a psychiatry elective into the pharmacy school curriculum can improve attitudes toward patients with mental health disorders. Future areas of research are warranted on the influence of specific components of a psychiatry elective that impact BMI scores and whether this translates to improved quality of care during clinical practice.

Development of an interprofessional rotation for pharmacy and medical students to perform telehealth outreach to vulnerable patients in the COVID-19 pandemic.

This report describes an interprofessional rotation for pharmacy and medical students focused on telehealth outreach to patients at high risk for delays in care due to the COVID-19 pandemic. The curriculum was designed around core competencies of interprofessional education. Student activities included participating in interprofessional huddles, collaborating on patient interviews, and practicing interprofessional communication. Three pharmacy students and two medical students completed the rotation. Evaluation was conducted via survey and exit interview. All students successfully increased their knowledge of their own and others' professional roles and demonstrated interprofessional communication and collaboration through telehealth.

Combination nicotine replacement therapy: strategies for initiation and tapering.

Several studies and meta-analyses have demonstrated the efficacy of combination nicotine replacement therapy (NRT) for patients who wish to quit smoking. However, there is limited guidance with respect to initiation and tapering of combination NRT. We attempt to review the evidence and rationale behind combination NRT, present the dosing used in combination NRT studies, and propose a step-down approach for tapering of combination NRT with integration of behavioral strategies.

Dosing strategies for switching from oral risperidone to paliperidone palmitate: Effects on clinical outcomes.

INTRODUCTION: There are currently no guidelines for switching patients from oral risperidone to paliperidone palmitate (Invega Sustenna®). Furthermore, the paliperidone long-acting injectable (LAI) package insert does not recommend bridging with oral antipsychotics, which may result in inadequate serum concentrations in patients on ≥4 mg/d risperidone. METHODS: This study evaluated the effects of suboptimal dosing and bridging in patients switched from oral risperidone to paliperidone LAI on hospitalization days, emergency department (ED)/mental health urgent care visits, and no-shows/cancellations to mental health appointments. Patients were categorized into optimal or suboptimal dosing based on their loading and maintenance paliperidone doses. Patients on risperidone ≥4 mg/d were categorized as bridged if they received risperidone for ≥7 days after the first paliperidone injection. RESULTS: There were no significant differences in outcomes between optimally and suboptimally dosed patients. There were statistically significant reductions in hospitalization days in patients who were bridged compared with patients who were not bridged. There were statistically significant reductions in hospitalization days and ED/mental health urgent care visits after switching to paliperidone LAI. DISCUSSION: The results of this study indicate that bridging patients who are on ≥4 mg/d risperidone, when converting to paliperidone LAI, is associated with reductions in hospitalization days. However, more research is required to determine the optimal dose and duration of the bridge. The results also indicate that switching patients from oral risperidone to paliperidone LAI, even if the dose is suboptimal, is associated with reductions in hospitalization days and ED/mental health urgent care visits.