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This is the primary outcomes paper for CTN-0105.
Background: Pharmacists play a key role in combating the opioid-related overdose epidemic in the United States (US), but little is known about their experience and willingness to deliver preventive services for opioid use disorder (OUD).
Aims: This study seeks to identify correlates of pharmacists’ concerns about drug use problems (prescription drug misuse/use disorder and illicit drug use/use disorder) as well as their practice experience delivering preventive services for OUD (e.g., asked about opioid use, provided advice, made a referral) and willingness to provide services to patients with drug use problems.
Design: An online survey of licensed US pharmacists was conducted. Participants were recruited from Community Pharmacy Enhanced Services Networks (CPESN) and state pharmacist associations (N=1146).
Findings: Overall, 75% of surveyed pharmacists indicated having concerns about opioid use problems, and 62% had concerns about non-opioid drug use problems at their pharmacies. Pharmacists who were White, practiced at a rural location, worked at a chain pharmacy, had not received opioid-related training in the past year, or practiced screening patients for opioid use had elevated odds of perceiving concerns about opioid use problems in their practice settings. Pharmacists who were White, practiced at a rural location, or had not received opioid-related training in the past year had elevated odds of perceiving concerns about non-opioid (illicit) drug use problems. Being male, being White, or having received opioid-related training were associated with increased odds of screening patients for opioid use problems. Being White, having practiced at a rural location (vs. an urban location), being a pharmacy owner/manager, or having received opioid-related training were associated with increased odds of delivering opioid-related advice/intervention. Being male or having received opioid-related training were associated with increased odds of making a referral to OUD treatment. Finally, being male, being White, having practiced pharmacy services for under 6 years, having received opioid-related training for 2 h in the past year, or having performed OUD-related preventive services (asked about opioid use, provided advice, or made a referral) were associated with increased levels of commitment/readiness for providing care to patients with drug use problems.
Conclusions: The overall findings highlight pharmacists’ involvement with OUD preventive services. It is critical to promote opioid-related preventive service training for pharmacists and provide incentives/tools to help initiate a structured practice of delivering such preventive services.
Related protocols: CTN-0105
The U.S. has been experiencing a devastating opioid epidemic with enormous negative impacts on public health across the country. While efforts to reduce opioid prescribing have been successful, rates of opioid use disorder (OUD) continue to surge, with 300-400% increases among some populations.
Medications for opioid use disorder (MOUD), like methadone and buprenorphine, are effective strategies for treatment of OUD and reducing overdose risk. However, medication treatment rates continue to be low across the U.S., and the COVID-19 pandemic is making it even more difficult than usual for people to connect with care.
Given the challenges of getting and keeping people in treatment, expanding the role of community pharmacies may be one solution. Pharmacists have specialized training, high levels of consumer trust, and are often widely available in communities. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD in the past decades, but U.S. pharmacists have continued to be blocked from prescribing medications for OUD and are only currently allowed to dispense methadone for pain.
Two NIDA Clinical Trials Network trials are investigating the use of pharmacies in this role:
- CTN-0093, Validation of a Community Pharmacy-Based Prescription Drug Monitoring Program Risk Screening Tool, is working in community pharmacies to validate a national prescription drug monitoring program-based metric that will allow pharmacists to triage and understand care needed by patients with prescription opioid-related risk, including OUD.
| - CTN-0105, Integrating Pharmacy-Based Prevention and Treatment of Opioid and Other Substance Use Disorders: A Survey of Pharmacists and Stakeholders, is working to understand the current status, knowledge, and attitudes of pharmacists in the U.S. toward identification, brief intervention, referral, and MOUD provision.
U.S. policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based MOUD care, through research, education, practice, and industry changes.
Conclusions: Advancing community pharmacy-based MOUD services could make a critical difference in addressing the opioid epidemic in the United States, helping to mitigate the fallout from COVID-19 on people seeking help with their opioid use, and getting individuals the life-saving care they need.
Related protocols: CTN-0093, CTN-0105