Assessing Perceptions and Medication Disposal Habits in Rural Michigan.

Background: Inadequate or inappropriate medication disposal is a public health concern that may lead to increased community risk of accidental poisonings, substance misuse, and environmental pollution. Objective: The study's primary objective was to assess medication disposal knowledge and practices of Michigan residents living in rural, underserved areas. Secondary objectives included determining baseline perceptions of at-home drug disposal kits and examining the impact of an educational video intervention on at-home drug disposal kit perceptions. Methods: To measure the objectives, an online 15-question survey was deployed to the general public via convenience sampling from local organizations working with drug disposal. The survey questions assessed medication disposal knowledge and practices in underserved, rural Michigan. Participant responses were assessed categorically and numerically. Results: Inclusion criteria were met by 97 survey participants. Results indicated that Michigan rural residents, regardless of various demographic factors, would benefit from increased drug disposal education. Specifically, at-home drug disposal kits and medication drop boxes have the highest need for additional education. Perceptions related to home disposal safety and ease of use improved significantly with an educational video intervention. Conclusion: All rural residents, regardless of demographics, would benefit from increased drug disposal education. A short, educational video can impact thoughts and attitudes related to at-home drug disposal kits. Similar interventions may be successful in other rural, underserved areas.

Impact of a statewide community pharmacy approach to opioid harm reduction.

BACKGROUND: The past several years have seen sharp increases in opioid overdose mortality. Harm reduction resources, such as nonprescription syringes and naloxone, are used to save lives. OBJECTIVES: To develop a statewide approach to increase the use of opioid harm reduction services through community pharmacies. PRACTICE DESCRIPTION: The North Carolina Association of Pharmacists was awarded a grant to address opioid mortality across the state, using community pharmacies to address opioid use disorder. PRACTICE INNOVATION: A statewide, standardized approach was implemented to increase knowledge and use of opioid harm reduction resources in the community pharmacy setting. EVALUATION METHODS: Pharmacies were offered training related to harm reduction. Participating pharmacies provided monthly updates related to staff training, syringe access status, naloxone kits distributed, and comments about how the training was changing their practice. At the project conclusion, pharmacies provided retrospective naloxone dispensing data along with naloxone dispensing during the intervention period. Pharmacies shared the greatest benefit of the program, a potential change to make implementation simpler, and the biggest change in the pharmacist(s) as a result of the project. Descriptive statistics were used to analyze data. RESULTS: A total of 58 pharmacies across 33 counties participated in the harm reduction project. Of the 100 North Carolina counties, 15 counties were identified as high-need, and 14 of the 15 high-need counties (93%) participated in this project. Of the 58 participating pharmacies, 40 pharmacies (69%) had or implemented a nondiscriminatory nonprescription syringe policy within their pharmacy. During the baseline period (January 1, 2018, to June 15, 2018), 177 prescriptions for naloxone were dispensed by participating pharmacies. During the intervention period (January 1, 2019, to June 15, 2019), 639 prescriptions for naloxone were dispensed, representing a 361% increase in naloxone dispensing. CONCLUSION: The successful implementation of a standardized, statewide approach increased access to harm reduction services.

A standardized team-based approach for identifying naloxone-eligible patients in a grocery store pharmacy.

OBJECTIVES: To define a standardized team-based approach to identify naloxone-eligible patients in a community pharmacy and to evaluate the impact of the approach on the number of naloxone orders dispensed. SETTING: Two locations within one district of a chain pharmacy. PRACTICE DESCRIPTION: Kroger is a national grocery store pharmacy. PRACTICE INNOVATION: A standardized team-based approach was implemented from November 2017 to February 2018 into the dispensing workflow to identify naloxone-eligible patients. Training was provided to team members (e.g., pharmacist, student pharmacist, technician) at the intervention store. Persons age 18 years and older who met more than 1 of the following criteria were included: greater than or equal to 50 morphine milligram equivalents per day, concurrent benzodiazepine and opioid use, fentanyl patch greater than or equal to 25 µg/h, and documented or verbal history of overdose or substance use disorder. Persons were excluded if they were younger than 18 years, did not speak English, or received an opioid prescription of less than 5 days' duration and no opioid exposure during the previous 30 days. EVALUATION: If inclusion criteria were met, a clinical flag was placed in the dispensing system, alerting the pharmacist to speak with the patient at pick-up. The pharmacist educated the patient on the risks of opioid medications and the benefits of naloxone and then offered to dispense naloxone. The control store followed standard of practice. Data were evaluated using descriptive statistics. RESULTS: The intervention and control store each dispensed 3 naloxone orders from November 2016 to February 2017. During the study period, 39 persons were identified as eligible for naloxone, and 11 naloxone orders were dispensed at the intervention store (28.2%); 2 naloxone orders were dispensed at the control store. A standardized team-based approach resulted in dispensing 8 additional naloxone orders at the intervention store, representing a 367% increase compared with the prior year, when this approach was not used. CONCLUSION: A standardized team-based approach was successfully implemented in a grocery store pharmacy and resulted in increased naloxone dispensing to naloxone-eligible patients.

Patterns of heroin use following index prescription opioid exposure.

OBJECTIVE: This study examined the means of obtainment, indication, and prescriber of an index opioid in self-reporting heroin users. DESIGN: Cross-sectional, observational study. SETTING: A survey was submitted by participants in the United States with current or past heroin use. PARTICIPANTS: Three hundred twenty-three participants greater than 18 years of age completed the survey. MAIN OUTCOME MEASURE: Participants were surveyed regarding prescription opioid use prior to heroin initiation and spe-cifically how they were obtained. Surveys were comprehensive in nature, divulging information including which opioid(s) was/were used, how they were obtained, by which prescriber (if prescribed), and if there was a diagnosis for chronic pain. RESULTS: Roughly 47 percent of participants reported using prescription opioids prior to heroin. The most commonly used prescription opioid prior to heroin initiation was oxycodone (92.5 percent). The most common acquisition of opioids was through the prescribing of a physician, which occurred in roughly 63 percent of cases. These prescriptions were obtained most often from primary care physicians and emergency departments. Only 34 percent of participants reported being diagnosed with a chronic pain condition prior to using heroin. CONCLUSIONS: This study further supports the role that prescription opioids play in the transition to heroin use. It suggests that oxycodone is the most common prescription opioid used prior to heroin initiation. Additionally, it reports descriptive information as to how and where prescription opioids are obtained.