Academic Pharmacy Now: 2019 Issue 2

Academic Pharmacy

The News Magazine of the American Association of Colleges of Pharmacy

NOW

Volume 12 2019 Issue 2

Special Issue:

The Opioid Crisis Pharmacy schools are educating students and patients and taking steps to effect change. 8

Pharmacists Help People Live Healthier, Better Lives.

who we are @AACPharmacy

Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy

Pharmacists Help People Live Healthier, Better Lives.

1400 Crystal Drive, Suite 300 P Arlington, VA 22202 703-739-2330 P www.aacp.org Founded in 1900, the American Association of Colleges of Pharmacy is the national organization representing the interests of pharmacy education. AACP comprises all accredited colleges and schools of pharmacy, including more than 6,600 faculty, approximately 63,800 students enrolled in professional programs and 4,800 individuals pursuing graduate study.

NOW

CEO & Publisher

Lucinda L. Maine Editorial Advisor

Lynette R. Bradley-Baker

Editorial Director

Maureen Thielemans Managing Editor

Letters to the Editor

Jane E. Rooney

We welcome your comments. Please submit all letters to the editor to communications@aacp.org.

About Academic Pharmacy Now

Academic Pharmacy Now highlights the work of AACP member pharmacy schools and faculty. The magazine is published as a membership service.

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For address changes, contact LaToya Casteel, Member Services Coordinator, at lcasteel@aacp.org.

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©2019 by the American Association of Colleges of Pharmacy.

All rights reserved. Content may not be reprinted without prior written permission.

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Academic Pharmacy NOW  2019 Issue 2

Volume 12 2019 Issue 2

@AACPharmacy a look inside

community impact

5

News in Brief • Ole Miss Professors Receive Grants to Fight Opioids

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• MCW Clinics Offer Healthcare Services in Underserved Communities

8 Confronting

the national Opioid Crisis

Sponsored Content

Patient-centered EHR Teaches Students the Technology and the Gravity of Pharmacy

Opioid abuse, now a public health crisis in the United States, presents an urgent call to action to the pharmacy community. Pharmacy schools are educating students and patients and taking steps at local and national levels to effect change.

10 Introduction 12 A Call to Action 15 Strategies for Smarter Service 18 Expanding Naloxone Awareness and Use 20 Doubling Down on Drug Disposal 24 Delivering Straight Talk on Opioids

@AACPharmacy

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A Reinvented Portrait of the Pharmacist Pharmacists joined voices to change perceptions and brainstorm strategies to transform the practice at INvolve 2019.

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#PharmEd19: Put Your Career First in the Second City Connect with colleagues in Chicago and learn from experts in leadership, education and science, including keynote speaker and Pulitzer Prizewinning historian Dr. Doris Kearns Goodwin.

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community note publisher’s impact

Dear Colleagues: Imagine my surprise when the request came for a phone consultation with Dr. Victor Dzau, president of the National Academy of Medicine (NAM), around this time last year. I’m privileged to serve on the Research!America board of directors with Dr. Dzau and have come to appreciate his insights and commitment to excellence across the healthcare spectrum. It might have been a piece of business from Research!America that stimulated the request for a call.

Actually, it was an interesting question that most of our readers would say was so very obvious. He informed me that the NAM had been asked to coordinate a new action collaborative on opioids that aimed to engage key players across the public and private sectors. Academic medicine was quick to come to the table and his question was, “Should the collaborative also seek to engage academic pharmacy?” Without hesitation my answer was “Absolutely!”

This engagement was slightly before the AACP Public Affairs and Engagement team decided to embark upon the opioid scan that is described in this issue of Academic Pharmacy Now. There had been a feature in 2016 on the work of several AACP member institutions that revealed pharmacy faculty and students were involved in drug abuse education and prevention, as well as original research on better approaches to pain management. The staff and our Substance Use Disorder Special Interest Group set about creating a more comprehensive picture of our collective contributions, and the results are truly remarkable. There is no question that pharmacy aims to provide solutions to the crisis in many forms.

AACP did join the NAM Action Collaborative on Countering the U.S. Opioid Epidemic and I serve on the Education and Training Workgroup. That group is exploring the gaps between the education of key disciplines and practice behaviors across the U.S. We will also define how accreditation, certification and discipline-specific regulations align with the goals of preventing additional cases of addiction through more appropriate pain management. The ultimate aim for the overall effort seeks to reduce the incidence of fatal drug overdoses. Our work can’t progress too rapidly in that regard.

NAM will soon cast a wide net and invite additional organizations to become part of the network for this action collaborative. AACP will make that information available to all members as soon as it is received.

In the meantime, keep up the great work that is going on all across the country.

We look forward to providing the visibility that decisively reveals that academic pharmacy is definitely “in the game and playing hard.”

Sincerely,

Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher

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News in Brief Ole Miss Professors Receive Grants to Fight Opioids Dr. David Colby, professor at The University of Mississippi School of Pharmacy, received a grant from the National Institute on Drug Abuse (NIDA) to develop new treatments for addressing the opioid crisis. Colby hopes to develop a therapy for drug addiction by studying the medicinal chemistry of certain compounds that can lower the anxiety some patients experience when withdrawing from an addiction. Dr. Jason Paris, assistant professor of pharmacology, received a separate NIDA grant to combat opioids’ harmful effects on the HIV-infected brain.

“My research group is developing molecules that may have potential use in the treatment of drug addiction,” said Colby, associate professor of medicinal chemistry in the Department of BioMolecular Sciences. “This work is critical in the context of the mission of NIDA at the National Institutes of Health because of the impact of the opioid epidemic in the United States.” Through this research, Colby’s lab discovered a new class of compounds that have the potential to treat addiction more effectively than existing therapies.

Paris, who also teaches in the Department of BioMolecular Sciences, said the idea behind the grant he received is to find potential ways to target the damage caused by the central infection. “People who are dependent on opioids and are also HIV-positive are at risk for developing AIDS and have a quicker decline in brain health. We are working to find natural compounds that can reverse this.”

HIV infections and opioid abuse tend to be found together, since intravenous drug practices, such as those associated with heroin, can transmit the disease. Moreover, even HIV patients who don’t abuse drugs are more likely to experience chronic pain and be prescribed opioids. This has researchers such as Paris looking for new therapies that can work with HIV medications to decrease some of the most negative effects of opioid use in those with the disease.

MCW Clinics Offer Healthcare Services in Underserved Communities The Medical College of Wisconsin (MCW) School of Pharmacy launched MCW Neighborhood Partners, a pharmacistled, community-based health screening and care referral

service in Milwaukee, with its first location that opened this March. The program was developed in collaboration with founding community partner Next Door, an early childhood education and social service organization. Services will include health and wellness screenings, health promotion, disease prevention, nutrition counseling and patient health assessments.

MCW President and CEO Dr. John R. Raymond, Sr., and his wife, Maggie, provided the initial impetus for the concept for MCW Neighborhood partners last fall through a gift of $525,000 to establish the Community Health and Service Learning Fund. MCW Neighborhood Partners’ locations will be fully staffed by School of Pharmacy students and faculty members. Dominika Krynicka, class of 2020, was the first student pharmacist selected to participate in a clinical rotation at MCW Neighborhood Partners. She volunteered to administer health screenings to community members at the Next Door Walk for Children in May 2018 and the event inspired her to become more involved in the Milwaukee community. She gained a valuable skill set working with faculty and staff assisting in the development of protocols, documentation software and processes to assist in health screenings.

“Working with underserved patients had pushed me to step out of my comfort zone and to learn to empathize with individuals who think and live differently than I do,” she said.

“This has been valuable in growing my patient education style and ability to customize patient interactions.”

Students can be forces for change in the communities they serve, said Dr. Michael DeBisschop, a MCW School of Pharmacy professor involved with the clinic. “Our students have the knowledge and training necessary to perform physical assessments and screening tests as well as to deliver education to help prevent and treat disease. Pharmacists can also administer immunizations, answer questions about managing medications and help patients find the most affordable and effective options.”

The program has the potential to decrease negative health outcomes that are a direct result of treatable diseases in medically underserved areas. “Our goal is to work toward eliminating health disparities by providing enhanced care for patients close to home and from a provider they trust: the pharmacist,” noted Dr. George E. MacKinnon III, founding dean of the MCW School of Pharmacy.

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Sponsored Content

Patient-centered EHR Teaches Students the Technology and the Gravity of Pharmacy Pharmacy faculty are using an innovative EHR that gives students more than an education, it gives them practice. With this new applied teaching tool, students are no longer handed a paper case with a paragraph synopsis, but must search the educational medical record, read notes, look at lab work and piece the patient puzzle together. Cases become as multifaceted as individuals and the material resonates with students because it circles back to why they chose pharmacy— to help people.

This learning platform, called EHR Go, is used in all years of pharmacy education as a hands-on teaching tool. “It’s like a virtual grand rounds every day in pharmacy class,” said Kathleen Annala, CEO and President of Archetype Innovations, LLC, creators of EHR Go. Students work up diverse patient cases. Photographs bring patients to life and give students the sensation, ‘This is a real person.’ Faculty can be creative with their teaching and the platform helps them personalize care simulations.

As a professor, Annala saw her students were always looking for that human connection. She wove her experience as a nurse into her lessons, not just teaching the physiology of a burn, per se, but sharing the story of a little boy in the foster care system who got burned playing with a barbeque lighter. “When you bring that holistic way of seeing the world into the classroom, it makes the content go from dry and clinical to a very human, understandable experience where the numbers matter because this little boy is in pain,” Annala said. “Students immediately take the case more seriously, they start engaging with the material, and when done through EHR Go, it becomes all the more realistic.”

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Educational EHRs have elevated case-based learning and Annala has played a part in its progression since its conception. She moved into education early on in her nursing career and because she was young, it was presumed she was a technology whiz. Nearly 20 years ago, she was handed a project to bring a computerized electronic health record system into the curricula for healthcare students. She saw the vision for EHR Go then, she saw the educational EHR should be the center of case-based learning and interprofessional education, just as a person should be the center of a case study.

Barriers—institutional, technological and financial — stopped Annala’s vision from fully coming to fruition while she was a teaching faculty. In 2008, she took a leap with her business partner and husband, Don Annala, to create the ultimate educational EHR, the one she originally envisioned, the one that has evolved into EHR Go, the only educational EHR tailored to pharmacy and interprofessional education.

“Where EHR education began was to teach the EHR as a technology itself without cases. I think that’s the wrong direction, it’s the direction a lot of our competitors still use, I just don’t think it’s the right direction for students because it puts the focus on technology when the focus should be on patients and care,” Kathleen Annala said. “We believe the student learns the healthcare technology innately, through regular interaction with patient information. Learning course content through the EHR, the student becomes an EHR native. That’s why we created EHR Go, to make a system that lends itself to maintaining case information, creating case information and using case information, that’s what was missing.”

Sponsored Content

“Of all the healthcare disciplines, pharmacy has the widest educational scope. Pharmacists have to be experts in core course work like chemistry, but they also have to be experts in what nursing learns and what medicine learns, so they have to branch out, and that’s why EHR Go suits them so well, it helps pharmacy education reach its inherent need to be multifaceted.” ­ Kathleen Annala, CEO and President of Archetype Innovations, LLC, — Creators of EHR Go

When Dr. Deepti Vyas, associate professor at the University of the Pacific, started using EHR Go in her therapeutics courses in 2016, it revealed an issue: Her students struggled with order entry (especially when entering orders for intravenous drugs), they had difficulty selecting the correct formulation, diluents and frequency, and they did not always realize how easy it was to make a mistake. Before EHR Go, many students were not getting any practice entering orders until after they graduated.

“From a patient safety perspective, EHR Go has been vital for my students,” Vyas said. “Students understand if they enter medications incorrectly, there’s potential that they could cause patient harm. It’s very real to them, ‘I can make a mistake very easily. I can cause patient harm very easily. I need to think about what I’m doing before I approve an order, I need to collect all the pieces of information I need, because if I don’t, I could harm a patient.’”

Vyas also uses EHR Go in her interprofessional education affiliations, as her pharmacy students share cases with nurse practitioner students from the University of Missouri in Kansas City, working up patients and collaborating on treatments. By working across campuses, across disciplines, students gain such rich experiences that working in interprofessional teams becomes second nature in practice.

“Of all the healthcare disciplines, pharmacy has the widest educational scope,” Kathleen Annala said.

“Pharmacists have to be experts in core course work like chemistry, but they also have to be experts in what nursing learns and what medicine learns, so they have to branch out, and that’s why EHR Go suits them so well, it helps pharmacy education reach its inherent need to be multifaceted.”

Faculty can easily edit cases on EHR Go, removing information that does not yet apply or adding nuance to enliven discussion. Faculty can write their own clinical experiences into a case, sharing personal knowledge with students in an applicable way. “I have seen faculty do that in pharmacy, especially,” Kathleen Annala said. “They’re our most prolific creators of content.” And faculty can reach out to the company, share what they would like to see the product do and see those changes made, sometimes that very day.

A true teaching tool, EHR Go is crowd-sourced and community-based. Faculty feel they can take ownership of it. Students feel professional when they use it. To schedule a personalized, online demonstration of EHR Go, or receive more information, visit www. ehrgo.com/pharmacy or call 877-742-3926.

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community impact

Confronting the national

Opioid 8

Academic Pharmacy NOW  2019 Issue 2

community impact

Crisis Opioid abuse, now a public health crisis in the United States, presents an urgent call to action to the pharmacy community. Pharmacy schools are educating students and patients and taking steps at local and national levels to effect change.

By Jane E. Rooney

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Introduction A Call to Action Strategies for Smarter Service Expanding Naloxone Awareness and Use Doubling Down on Drug Disposal Delivering Straight Talk on Opioids

It was a record-setting year, but in the grimmest terms: Drug overdoses reached a new high in 2017, with 47,600 deaths caused by drugs such as fentanyl and heroin as well as prescription drugs, according to the Centers for Disease Control and Prevention (CDC). Deaths attributed to opioids in the United States were nearly six times greater in 2017 than they were in 1999. Opioids were involved in more than two-thirds of overdose deaths in 2017, and U.S. overdose death rates linked to synthetic opioids increased more than 45 percent from 2016 to 2017.

A report from the Office of the Surgeon General and the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that the crisis is being driven by three trends: an increase of prescription opioid overdose deaths since 1999; the fourfold increase in heroin overdoses since 2010; and the tripling death rate for synthetic opioids like fentanyl since 2013. A recent New York Times article noted that drug overdoses have contributed to a fall in life expectancy and are now the leading cause of death for adults under 55.

Despite this bleak picture, there is a glimmer of good news. Opioid prescribing was down 28 percent since it peaked at 81.3 prescriptions per year per every 100 Americans in 2012, according to a Washington Post editorial published earlier this year.

CDC data show a leveling off of prescription drug deaths, which could be due to prescription drug monitoring programs. Through a series of articles in this issue, Academic Pharmacy Now will explore what is being done on the national level to address the crisis and the role academic pharmacy is playing; what research projects pharmacy schools are pursuing; and what other activities schools are engaged in to help patients and providers as well as to prepare future pharmacists to take the next steps to eradicate this epidemic.

Surveying the Landscape To discover how involved they are and what types of activities pharmacy schools are undertaking to combat this public health crisis, AACP conducted an environmental scan from July to September 2018. Respondents submitted a summary of activities and whether any outcomes emerged (e.g., the number of students educated or patients taught, peer-reviewed papers, etc.). With 144 schools (75 percent) submitting at least one activity, AACP collected 398 activities for its final analysis, which is available at www.aacp.org/opioid.

“We want to provide that information so people within the Academy will be able to learn from each other and maybe even partner together. No one wants to spend time recreating something if it’s already been done.” ­— Dr. Lynette Bradley-Baker

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“The opioid epidemic is something that is ever-present in all walks of life and we understand the role that pharmacists could and should play with helping to combat it or prevent it in the first place,” said Dr. Lynette Bradley-Baker, AACP’s senior vice president of public affairs and engagement.

“Various institutional members are doing some great things, such as building coalitions and working with other institutions on their campus to help with the education of future practitioners, but we did not have a sense of what academic pharmacy as a whole was doing to help with this. We wanted to be able to have conversations within the healthcare community about what academic pharmacy is doing in this area.

We want to provide that information so people within the Academy will be able to learn from each other and maybe even partner together. No one wants to spend time recreating something if it’s already been done.”

Midwestern University’s Chicago College of Pharmacy. “We now know who those leaders are and who has been working on this for a long time and has the experience. We can align them with others who are motivated so their efforts are much more productive. Even if this is not a specialty you’re working in, you know it’s affecting a large enough percent of the population that it impacts other co-morbidities. The scan gives us a better idea of the breadth of this problem and how many people are working on it.”

The SIG’s mission is to collaboratively promote and enhance interprofessional and public education concerning substance misuse prevention and treatment, to promote and foster the provision of evidence-based substance use disorder treatment and recovery support services for professionals and the public, and to promote scholarly inquiry concerning substance use disorders as it impacts the profession of pharmacy, pharmacy collaborators and the public. Tran said the SIG wants to do more collaborative, interdisciplinary research on substance use and to learn what roles SIG members are playing in terms of advocating for policy change. She thinks the topic is included in the curriculum at most schools, but in a limited way.

When AACP sent out the call for information, it broadly defined an “activity” as a collaboration, initiative, lecture, partnership or program, and did not restrict participation based on who was involved (whether it was an individual, a department or a group of students). AACP offered guidance in terms of categories, which included advocacy, education, teaching, practice, research and/or service. “The majority “It’s problematic because there are not a lot of pharmacists of submitted activities had an education focus,” Bradleywho are specifically trained in substance use disorder or Baker said. “The one thing we expected to have more of was research. We know that a lot of our schools are involved with addiction,” she acknowledged. “Even the people teaching it may not be as knowledgeable about recent advances. I think investigation of new agents for pain that are non-addicting. everybody is aware we need to do more but we’re doing it We also have research dealing with perceptions regarding naloxone and perceptions about the role of the pharmacist in through trial and error. Other healthcare professions are going through the same thing. How do we address this? Are we fighting the epidemic.” doing it effectively? Who do we turn to for expertise?”

Anyone can access AACP’s searchable database, which The Chicago College of Pharmacy is addressing issues such includes a summary of each school’s activity and a point of contact. Bradley-Baker added that AACP is devising a process as language terminology, stigma and naloxone as required training for all pharmacists. “We are spreading it throughout to continuously collect information on what schools are the four years in the curriculum so it has more of an impact doing to address the crisis and will likely put out a call for updates in July. “There will be more schools that submit their and allows students to think more about it, and maybe help in the community and think about substance abuse and activities in this area. Everyone is doing something. They are awareness,” Tran explained. Pharmacists across all discieducating and training students about the epidemic and getplines will have to address the opioid epidemic in some way. ting them to be part of the solution in their community.”

Increasing Involvement AACP’s Substance Use Disorder SIG helped classify the activities for the scan and is taking the lead on analyzing the findings to prepare a summary for the American Journal of Pharmaceutical Education. “There are a lot of people doing wonderful things. The scan provides more transparency and identifies the people leading this effort and resources we can turn to,” said SIG Chair Dr. Tran Tran, associate professor at

Given that the epidemic starts with medications and is treated with medications, she continued, “This is a really important role for pharmacists. They are naturally in a position to fill that role to make a dent in terms of combatting the issue. As an Academy, it’s important that we have people to spearhead that effort.”

Jane E. Rooney is managing editor of Academic Pharmacy Now.

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A Call to Action

Introduction A Call to Action Strategies for Smarter Service Expanding Naloxone Awareness and Use Doubling Down on Drug Disposal Delivering Straight Talk on Opioids

As the federal government recognizes the serious threat that opioids pose to communities nationwide, stakeholders including academia and provider groups are joining efforts to develop solutions.

By Dorothy Farrell, Ph.D., and Jeffrey Ekoma The federal response to the opioid issue intensified when then-Acting Secretary of the Department of Health and Human Services (HHS) Eric D. Hargan classified the crisis as a public health emergency in October 2017. The declaration, which was included in recommendations from the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, largely permitted the administration to use government resources to take expedited actions to address the situation. HHS and the Office of the Surgeon General reaffirmed the administration’s commitment to equip stakeholders with tools, resources and information to change the trajectory of the crisis in the United States. Following the Senate confirmation of James Carroll as director of the Office of National Drug Control Policy in January, the administration released its National Drug Control Strategy, which focuses on reducing the size of the drug-using population, reducing barriers to treatment services for those suffering from substance use disorder and reducing the availability of illicit drugs.

Recognizing the proliferation of opioids in communities, the Surgeon General released Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health in 2016. The report, updated in 2018 as Facing Addiction in America: Spotlight on Opioids, was the first by the Surgeon General that focused solely on substance use and addiction. That office also released a public health advisory urging Americans to be aware of how to use naloxone and to keep it within reach if they or a family member meet the criteria for being at risk for an opioid overdose.

HHS Priorities The HHS response is organized around a five-point strategy: 1. Better addiction prevention, treatment and recovery services. A centerpiece of HHS’s response to the crisis is the Opioid State Targeted Response (STR) grant program, through which $1 billion in funding has been allocated to states. The Opioid-STR program was authorized by the 21st Century Cures Act and is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). Intended to supplement existing activities within states, it supports needs assessment; strategic planning; analysis of statewide gaps and resources; and expanded evidence-based treatment practices, particularly medication-assisted treatment and recovery support services, for target populations. STR recipients are encouraged to coordinate prevention efforts with those funded by other federal entities, such as the Centers for Disease Control and Prevention (CDC).

Pharmacy schools have received STR grants to promote education, naloxone distribution and protocols and addiction medicine consultation in clinic.

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community impact

2. Better data. HHS recognizes that state and federal response has been hampered by outdated and incomplete information on adverse events related to opioid use, such as missing information on the specific drug involved for many overdose deaths. In 2018, the CDC released Opioid Overdoses Treated in Emergency Departments and the 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes in the United States. The CDC now also reports provisional data on overdose deaths monthly and has awarded states funding to support their surveillance efforts of opioid-involved morbidity and mortality and prescription drug overdose prevention. The Agency for Healthcare Research and Quality (AHRQ) is using data from the Healthcare Cost and Utilization Project to build an interactive “Fast Stats” tool containing patient data and geographic information about opioid-related hospitalizations, to enable research to advance evidence-based response to the crisis.

3. Better pain management. The National Pain Strategy is meant to serve as a guide toward achieving a system in which everyone receives appropriate, highquality and evidence-based pain management. The strategy encompasses professional education and training, public education, disparities, payment and care, services and payment and population research. Implementation is overseen by working groups of the Interagency Pain Research Coordinating Committee, which also coordinates the Federal Pain Research Strategy in conjunction with the National Institutes of Health. NIH also funds the Centers of Excellence in Pain Education at 11 academic institutions. These serve as centers for developing, evaluating and distributing curriculum resources focused on pain. Resources are available to pharmacy, medical, nursing and other health professional schools.

“We have so much to contribute, and too frequently the contributions of pharmacists and pharmacy schools are overlooked.

Participating in the NAM [National Academy of Medicine] activity helps remedy those omissions.” ­— Dr. Lucinda L. Maine

4. Better targeting of overdose-reversing drugs. SAMHSA joined with the Health Resources and Services Administration to provide funding to expand the availability of overdose-reversal medications in healthcare settings and support poison control centers in their efforts to provide treatment from misuse of prescription and illicit opioids. AHRQ has funded grants to study how naloxone can be distributed through communities, including in the pharmacy setting.

5. Better research. In 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, a trans-agency effort to transition scientific understanding gained from NIH research into effective solutions to the opioid crisis. This research encompasses understanding of the neurological basis of pain and addiction and alternative treatments for pain as well as studying treatment models for opioid use disorder and new forms of medication-assisted treatment. Nasal naloxone for overdose reversal, buprenorphine for treating opioid use disorder and studies showing the equivalence of buprenorphine and naltrexone all originated with NIH support. The HEAL Initiative Research Plan aims to improve prevention and treatment and enhance pain management. Funding opportunities so far have covered longitudinal study of antenatal opioid exposure, back pain, prevention strategies, new technologies to treat pain and addiction and the Justice Community Opioid Innovation Network. This network is a collaboration between NIH and community partners that will study how the criminal justice system can more effectively respond to the crisis.

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Legislative and Academy Efforts Concurrent with action by the administration, the 115th Congress passed the Substance Use Disorder that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6). The bipartisan agreement, which served as a legislative vehicle for separate opioid bills, modifies and creates federal programs and policies to help address the crisis. Signed into law on Oct. 24, 2018, the law lifts certain restrictions on Medicare and Medicaid coverage of treatment for substance use disorders and creates comprehensive opioid recovery centers, addresses over-prescription of opioids, supports research into alternative pain treatments and increases support for law enforcement to intercept fentanyl shipments. The law also included the Empowering Pharmacists in the Fight Against Opioid Abuse Act, which requires federal agencies to support training for pharmacists regarding when they are allowed to decline to fill an opioid prescription.

AACP is committed to joining in the national response to the opioid issue and is a participating organization in the National Academy of Medicine (NAM) Action Collaborative on Countering the U.S. Opioid Epidemic. The Action Collaborative, which is comprised of stakeholders ranging from academia, government and provider groups, seeks to facilitate the sharing of knowledge, develop initiatives and advance solutions to the crisis. AACP EVP & CEO Dr. Lucinda L. Maine is a member of the Collaborative’s Health Professional Education and Training Working Group. NAM reached out to AACP last year to learn about pharmacy education and how academic pharmacy is addressing the crisis.

Learn More 2018 Annual Sur veillance Report of Drug-Related Risks and Outcomes in the United States htt ps://s tacks.cdc.gov/ view/cdc/58547 a: Facing Addic tion in Americ tThe Surgeon General’s Spo ligh t on Opioids htt ps://addiction.surgeongeneral.gov/

H.R .4275— Empowering Pharmacists in the Fight Against Opioid Abuse Ac t htt ps://www.congress. gov/bill/115t h-congres s/ house-bill/42 75/tex t

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Maine said participation in the Collaborative was a no-brainer. “We have so much to contribute, and too frequently the contributions of pharmacists and pharmacy schools are overlooked,” she noted. “Participating in the NAM activity helps remedy those omissions.” Being part of the education and training group will also allow the pharmacy community to learn from what other disciplines are doing to educate their students and practitioners and enable truly interprofessional education related to opioids. Working groups are currently developing action plans, and the hope is that once those are in place, opportunities for schools and individuals to become involved in the Collaborative’s work will become clear.

AACP is also working with the other members of the National Conference of Pharmaceutical Organizations (NCPO), all of which have prioritized work on pain management and opioid misuse issues in their strategic agendas. The group, which met most recently in January, is sharing resources, forging alliances and reaching out to the administration to offer pharmacy’s commitment and support to make a positive impact. Maine remarked, “The sharing of activities over the past year was nothing short of amazing.”

Dorothy Farrell is senior director of science policy/chief science officer at AACP, and Jeffrey Ekoma is the former associate director of policy and professional affairs.

community impact

Strategies for Smarter Service

Researchers at pharmacy schools are designing tools that allow pharmacists to deliver evidencebased care to patients who use opioids.

By Dorothy Farrell, Ph.D. As medication experts, pharmacists can perform a key role in mitigating the risks to patients and communities associated with opioid use while still providing medications for patients who suffer from pain and offering non-judgmental assistance to those who struggle with using opioids properly. Pharmacists must embrace their position as an access point for public health intervention. States have recognized the central role pharmacists play in the response to the opioid crisis, by instituting prescription drug monitoring programs (PDMPs) and allowing pharmacists to dispense naloxone without a physician’s prescription. But many community pharmacists still face challenges providing services aimed at addressing opioid safety and misuse.

Assessing Risk

Introduction A Call to Action Strategies for Smarter Service Expanding Naloxone Awareness and Use Doubling Down on Drug Disposal Delivering Straight Talk on Opioids

Numerous tools are available to prevent diversion and promote safe opioid use, but researchers want to ensure that evidence-based strategies exist for deploying these tools. Pharmacists report that they receive insufficient guidance in using PDMPs, are unsure how to approach patients with concerns about opioid safety and have not been educated about naloxone distribution and use. In addition, they are typically not reimbursed for providing counseling and services related to opioid safety, and struggle to find time to provide these services in busy pharmacies. Faculty at pharmacy schools are designing and testing strategies that enable pharmacists to deliver evidence-based care that fits into existing workflows and leverages the specialized training pharmacists receive in medication safety to meet the needs of patients who use opioids.

Dr. Mark Strand, professor of pharmacy practice and public health at North Dakota State University, sees an opportunity to capitalize on community pharmacists’ unique position as the first point of contact for patients being prescribed opioids to promote prevention, safe use and full awareness of potential risks. The Opioid Risk Tool (ORT) from the National Institute on Drug Abuse is a brief, self-reported screening tool validated for assessing risk of opioid misuse in patients prescribed opioids for chronic pain. The researchers combined the ORT with a patient intake form that provides crucial information about a patient’s disease state(s) and complete medications list, information a pharmacist is often missing. This patient information provides a picture of the risks facing a patient who may, as Strand noted, be unknowingly starting down a dangerous path to opioid use disorder.

In 2017, Strand and his colleagues began a pilot training program for community pharmacists to implement risk screening and counseling and referral to resources

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for patients identified as being at heightened risk for harm due to opioid use. Unsurprisingly, the pilot study found that pharmacists were able to identify at-risk patients using the tools and training provided. But the researchers also found that pharmacists preferred having objective tools to gauge patient risk rather than relying strictly on professional judgment.

they had concerns about a prescription. Resolving these tensions requires prioritizing patient safety and emphasizing that consultation with a prescriber or referral to naloxone are protective, not punitive, measures. An essential feature is pharmacist education in non-judgmental communication styles based on motivational interviewing techniques.

Having neutral screening tools empowered pharmacists to begin conversations with patients and lowered the barrier for patients to accept advice about their risk. These conversations provide opportunities for patients to raise their own concerns, which may arise from history or experiences they might not share unprompted. The pilot program’s success resulted in state funding for ONE Rx (Opioid and Naloxone Education), a program to make the training available to all pharmacists in North Dakota. More than 900 patients have been screened so far, and 4.6 percent of patients have scored as high-risk for opioid use disorder, based on the ORT, while 28 percent were identified as being at risk of accidental overdose based on medication interactions, patient profile or disease states. This risk identification led to 4 percent of patients leaving the pharmacy with naloxone, reflecting their increased willingness to have a “fire extinguisher” at home.

The RESPOND toolkit supports processes that effectively address opioid safety while being workable even in busy urban pharmacies. The team developed an algorithm that pharmacists use to weigh information about the prescription and patient and determine if follow-up with either the prescriber or patient is indicated. The toolkit embeds the algorithm in a communication strategy checklist that promotes patientcentered, non-stigmatizing interactions. Online training modules provide pharmacists with information on the roots of the opioid crisis, the purpose and appropriate use of PDMPs, tools for communicating with patients and the value of naloxone. This additional training is intended to increase self-efficacy in providing patient services related to opioid safety.

Tools to Improve Communication Communication between pharmacists and patients is also at the heart of the Agency for Healthcare Research and Quality (AHRQ)-funded RESPOND (Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing) project at Oregon State University. Dr. Daniel Hartung, associate professor of pharmacy in the Oregon State University/Oregon Health & Science University College of Pharmacy, has worked with colleagues to create good practices for integrating PDMPs and risk assessment into pharmacy workflows. The goals are to help pharmacists systemize the way they use these tools to provide decision support when working with opioid prescriptions and to enhance communication between pharmacists and patients and pharmacists and prescribers.

To understand how pharmacists and patients considered the pharmacist’s role in opioid safety, the researchers convened focus groups. They found that while pharmacists and patients agreed pharmacists are responsible for patient safety, tensions exist between the obligation pharmacists have to prevent diversion of opioids and their responsibility for a patient’s well-being and safety. Patients felt stigmatized as drug-seekers when pharmacists questioned their prescriptions or contacted prescribers without speaking to patients first. And pharmacists expressed uncertainty about how to use PDMPs effectively and how to engage with patients when

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Having established the value and feasibility of pharmacist services for opioid users, the next step is developing sustainable models for service delivery and expanding use. The North Dakota team has shown that patient intake in their model takes an average of 4.8 minutes per patient for the pharmacist. State funding is currently enabling $20 payment to pharmacists for the service, while the team gathers evidence of the value of the intervention to share with a working group of third-party payers.

The ONE Rx program expansion is also creating a rich stream of data for further research. More than 50 pieces of information are being collected on each patient related to their medical history, disease states and medication lists.

These data help patients and pharmacists arrange for better individual care, but they also enable research on patient outcomes that is critical to improving care management for all patients and supports the value proposition of the services. Strand hopes projects like ONE Rx will help build a critical mass of pharmacists to provide these services with or without reimbursement. One additional part of any effective response to the crisis is recognizing the potential dangers presented by opioids and careful appraisal of the evidence base for prescribing practices. Many prescribers are slow to adapt alternative approaches to pain management and reduce reliance on opioids for chronic pain relief, but Strand and his colleagues continue to engage with prescribers as they seek to move prevention efforts further upstream. As

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Strand noted, “We need better and safer ways to manage non-cancer pain, including more holistic treatment plans for chronic pain patients, including non-opioid medication options.”

Pharmacy-Based Interventions The initial response to the opioid crisis focused on PDMPs and stemming the tide of prescription opioids entering communities. However, reducing the volume of prescribed opioids didn’t translate into lower overdose rates, which increased as opioid use shifted to non-prescription drugs like heroin and fentanyl. As Hartung noted, “We’re not going to be able to de-prescribe our way out of this problem.” Lowering overdose rates is going to require embracing harm-reduction approaches—overdose reversal through naloxone, widespread access to buprenorphine and other forms of medication-assisted treatment, syringe sales and promoting healthy behaviors among opioid users.

The Oregon group is now collaborating with Dr. Traci Green at the Boston Medical Center and Dr. Jeffrey Bratberg at the University of Rhode Island College of Pharmacy to conduct a large, multistate clinical trial investigating the effectiveness of a strategy to promote community pharmacy engagement in opioid-related harm reduction. With support from the National Institute on Drug Abuse, the team will combine RESPOND with approaches developed by the researchers in New England through the MOON (Maximizing OpiOid Safety with Naloxone) study. MOON focused on understanding how the public and pharmacists consider opioid safety and naloxone distribution in community pharmacies, to enhance their use as sites for naloxone dispensing.

The new study, RESPOND to PREVENT, will provide pharmacist and patient education and services to increase access to naloxone, buprenorphine and syringes in community pharmacies across four states. Patient behavioral and psychological outcomes will be measured along with assessments of intervention fidelity and dispensing rates. Together, these data will allow investigators to identify the factors that facilitate or inhibit implementation of effective, pharmacy-based interventions to prevent adverse events related to opioid use.

Ultimately, the studies in North Dakota, Oregon and New England, like many others across the country, aim to prevent opioid misuse and reduce the risk of overdose and other opioid-related harms. “Pharmacy is public health implemented in the community,” Bratberg pointed out. “If we teach our students and pharmacists to welcome all patients, we can provide a path to care for them.” Pharmacists can play a crucial part, but only if they embrace their role in ensuring opioid safety and promoting harm reduction.

Dorothy Farrell is senior director of science policy/chief science officer at AACP.

“Pharmacy is public health implemented in the community. If we teach our students and pharmacists to welcome all patients, we can provide a path to care for them.” ­— Dr. Jeffrey Bratberg

Learn More ONE Rx (Opioid and Naloxone Educat ion) htt ps://www. nodakpharmacy.com/onerx / RESPOND (Resources Encouraging Sa fe Prescr ipt ion Opioid & Naloxone Dispensing) projec t htt ps://pace.oregonsta te. edu/ca talog/respond-t ool kit MOON (Maximiz ing OpiOid Sa fet y wit h Naloxone) stu dy htt ps://www.bmc.org/ research/maximizingopioid-sa fet y-naloxonemoon-study

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Introduction A Call to Action Strategies for Smarter Service Expanding Naloxone Awareness and Use Doubling Down on Drug Disposal Delivering Straight Talk on Opioids

“I think students sometimes start working in the pharmacy and they immediately become jaded because they see the people coming in for pills. They really need to be able to see substance use disorders from the patients’ perspective.”

— Dr. Lindsay Acree

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Expanding Naloxone Awareness and Use Pharmacy schools are spreading the word about naloxone, helping to reduce opioid overdose fatalities.

By Emily Jacobs Amid the ongoing opioid crisis, the opioid antagonist naloxone is crucial in helping to reduce the rate of fatal overdose. Pharmacy schools and student pharmacists have emerged as key players in promoting naloxone’s use and making it more accessible. Studies show that community access to naloxone and overdose education are associated with a decrease in opioid overdose deaths. Lawmakers in several states have expanded access to naloxone, allowing more people to use it to prevent overdose. Meanwhile, communities have launched training programs to teach first responders and the public how to use naloxone properly. In many cases, pharmacy schools have been instrumental in bringing about these changes.

Ohio Student Pharmacist Provides Testimony Students at The Ohio State University College of Pharmacy contributed to the passage of House Bill Number 4, which helped expand access to naloxone across the state. Under this law, a pharmacist or pharmacy intern authorized by a physician or board of health can dispense naloxone without a prescription. Since the bill took effect in July 2015, more than 1,600 Ohio pharmacies have been able to dispense naloxone without a prescription via protocol. Previously, naloxone possession was limited to paramedics and first responders, and then expanded to active drug users and family members of at-risk individuals, under a physician prescription.

Dr. Kelsey Schmuhl, practice-based academic fellow at the Ohio State University College of Pharmacy, was one of the students involved in giving testimony supporting House Bill 4. While working as a pharmacy intern at Nationwide Children’s Hospital in Columbus, she connected with healthcare providers who had experience with patients with substance use disorder. Schmuhl developed a passion for promoting the use of naloxone and helped provide naloxone education to patients at Nationwide’s medication-assisted treatment clinic.

When the bill came up for debate in the Ohio House of Representatives, the Ohio Pharmacists Association encouraged Schmuhl to give testimony. Schmuhl was able to apply her teaching experience, using a real naloxone kit to demonstrate its use to the Ohio Health and Aging Committee. “Part of the bill actually allows pharmacy students to counsel and educate about naloxone, so for me to go in and talk to our legislators about the issue as a student was really powerful,” she said.

Providing testimony to the House also helped Schmuhl realize how crucial it is for student pharmacists to participate in political issues that could impact their

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“If we don’t have students and pharmacists advocating to push our profession forward, then we’ll never get anywhere. I think it’s important, as practicing pharmacists and as educators, to encourage our students to get involved in issues beyond the college of pharmacy.”

— Dr. Kelsey Schmuhl careers and patients. Lawmakers want feedback from “the people in the field,” she said. “If we don’t have students and pharmacists advocating to push our profession forward, then we’ll never get anywhere. I think it’s important, as practicing pharmacists and as educators, to encourage our students to get involved in issues beyond the college of pharmacy.”

While the bill has helped advance naloxone use, Schmuhl pointed out that there is still work to be done to expand access to the drug and reduce opioid overdose. In particular, the stigma of addiction makes many people reluctant to request naloxone, even legally.

To diminish the stigma, Schmuhl said, pharmacy schools should train students to take a harm-reduction approach.

Students should understand how to approach patients and engage with them in a “non-judgmental, non-coercive way.”

This can make people struggling with addiction, as well as their loved ones, feel more comfortable about requesting naloxone from a pharmacy.

West Virginia Training Saves Lives The harm-reduction approach has already benefitted the Charleston, West Virginia, metropolitan area. Faculty and students at the University of Charleston School of Pharmacy provide public naloxone trainings in partnership with the Kanawha-Charleston Health Department. These 30-45 minute trainings teach the proper use of naloxone in the event of an opioid overdose. Attendees learn how to recognize an opioid overdose; the risk factors of overdose; the importance of calling 911; and how to perform rescue breathing. Once they complete training, attendees receive naloxone kits, when available.

This public naloxone training began in April 2016 as part of the health department’s Harm Reduction Program (which started in December 2015) to target drug misuse and overdose. Originally intended to provide syringe exchange and wound care, the program later added naloxone training with the help of Dr. Lindsay Acree, assistant professor of pharmacy practice at the University of Charleston School of Pharmacy.

So far, the classes have been effective in helping to prevent fatal overdose. At least 444 former class attendees have requested additional naloxone kits after using theirs to help save a life, Acree said. The classes have also been educational for student pharmacists. The lessons and skills that students receive through their participation promise to have long-term effects on their future patients and the current opioid crisis.

Acree encouraged her students to help with the Harm Reduction Program. By meeting with community members who struggle with addiction, students have been able to hone their communication skills and develop a greater sense of empathy, Acree noted. “I think students sometimes start working in the pharmacy and they immediately become jaded because they see the people coming in for pills,” she said. “They really need to be able to see substance use disorders from the patients’ perspective.”

Although they have frequent interactions with “typical” pharmacy customers, students may not always interact with more disadvantaged community members. “They’re not seeing poverty, they’re not seeing homelessness, they’re not seeing other aspects of the communities that are often hidden,” Acree pointed out. Engaging with people through public health programs “opens that communication with a different population that they usually don’t communicate with.” This gives student pharmacists the practice they need for their future careers.

With greater empathy and improved communication, the pharmacy community may help curb the opioid crisis. Pharmacists can provide valuable education through their direct interactions with patients and prescriptions. Treating people with dignity, Acree said, can encourage more patients to pursue treatment. “My hope is that, because of the experience [students] have had, when they’re out in the pharmacies and they have that patient they’re worried about, they will be equipped to offer help.”

Emily Jacobs is a freelance writer based in Toledo, Ohio.

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Introduction A Call to Action Strategies for Smarter Service Expanding Naloxone Awareness and Use Doubling Down on Drug Disposal Delivering Straight Talk on Opioids

Doubling Down on Drug Disposal

Students are helping curb diversions and create new habits via safe medication disposal.

By Athena Ponushis

One of the greatest roles pharmacists play in the opioid crisis may be changing the public mindset about saving medications. Schools of pharmacy are reducing the accumulation of prescription medications in medicine cabinets, minimizing the risk that those drugs might be stolen and abused, by having student pharmacists connect with the public at drug take-back events to convince people that it is unsafe to keep prescriptions that are no longer needed. “The biggest motivator for safe medication disposal is really understanding where the problem of our opioid epidemic and controlled substance diversion comes from: legitimate prescriptions that have gotten into the wrong hands,” said Dr. Krystal Riccio, associate professor of pharmacy practice at Roseman University of Health Sciences College of Pharmacy.

Patients are motivated to give back their unused medications after seeing the connection between addiction and diversion of prescriptions, and student pharmacists are motivated to continue the cause, knowing that they are making an enormous impact. Students at the St. Louis College of Pharmacy (STLCOP) having been doing door-to-door drug take-backs since 2011, collecting more than 2,200 pounds of medications. The school was also a founding member of the Missouri Prescription Pill and Drug Disposal (MO P2D2), which has positioned more than 25 medication disposal boxes across the region. Between these efforts and the national take-back days organized by the Drug Enforcement Administration (DEA), 124 tons of medication have been collected in the St. Louis metro area since 2011.

At Roseman, tens of thousands of pounds of medications have been removed from Nevada communities at drug take-back events since 2010. Last year alone, students distributed nearly 2,000 safe disposal bags for controlled substances within the Las Vegas area. “It’s pretty crazy how quickly people responded to the call to dispose of their medications,” Riccio said. Such willingness showed Riccio that this is how to address diversion: by making safe medication disposal a habit.

“It’s incredibly helpful for students to see what people dispose of because I think that they have this perception that when they give medications at the pharmacy counter, patients take most of it and are adherent. When they see what patients are getting rid of, they realize that is not always the case.”

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Students on Roseman’s Drug Abuse Awareness Team participate in drug take-back events in the community.

Takeaways From Take-Backs “Schools partnering with their communities can have a direct impact on medication disposal,” said Dr. Amy Tiemeier, director of community partnerships, associate director of experiential education and associate professor of pharmacy practice at STLCOP. “Even though the DEA does national take-back days twice a year, many of our seniors have limited transportation, potentially limited mobility and they might find it challenging to get to one of those drop-off locations on take-back days.” The college partnered with the city Agency on Aging to reach residents in independent senior living facilities.

The school plans its door-to-door drug take-back for the week prior to the spring national take-back day. DEA officers escort students, adding the medications they acquire to the pile they will collect on the national take-back day, covering the cost of incineration. Students provide flyers to facilities in advance so residents can have their medications ready to go. Then Tiemeier and students, sometimes accompanied by facility managers to lend familiarity, knock on doors and take back unused medications.

“It’s incredibly helpful for students to see what people dispose of because I think that they have this perception that when they give medications at the pharmacy counter, patients take most of it and are adherent. When they see what patients are getting rid of, they realize that is not always the case,” Tiemeier said. “Students also think that people get rid of their medications when they expire, but sometimes we see things that are five, 10 years old or even older.”

Recently, Tiemeier and her students took back eye drops that were from the late 1990s. The woman said she was holding on to them just in case something happened to her eyes. “It was a good educational opportunity for us to say, ‘This is really not safe. These are not good anymore.’ But people say, ‘Oh, this medicine

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Expired or unwanted medication goes into dedicated waste bags at drug take-back events.

helped me and I don’t want to spend the money again,’ so they will hold on to it,” she said. “It’s good for students to see those kinds of things and realize that they need to be educating at the pharmacy counter when they dispense and cannot just assume adherence.”

Looking at refill rates for adherence may be the best measure that pharmacists have, but in doing these take-backs, Tiemeier and her students have seen that people do some strange things with their medications, like pouring their refills into expired bottles or getting their refills but only taking a few pills. “From a perspective of looking at a database, it looks like they have been adherent because they keep getting their refills, but when you actually go and look, they haven’t been taking their medications at all,” said Tiemeier, who also serves as president of the MO P2D2. The St. Louis College of Pharmacy maintains a website that lists permanent medication disposal boxes in the area and students volunteer at the city’s Earth Day activities, which includes a recycling extravaganza where people can safely toss out their medications, drive-through style, as they recycle other goods.

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Taking Action Upstream Students at Roseman started a Drug Abuse Awareness Team (DAAT) in 2007 after hearing that a nearby high school found black tar heroin on its campus. Roseman student pharmacists thought high school students might make smarter choices if there were better efforts to educate them. Roseman students created a curriculum, had it approved by the school district and began visiting middle schools and high schools. “We identified that disposal was a big issue,” Riccio noted. “We had to get people to get rid of the unnecessary medications that were in their homes so that they were not offering easy access to many of the medications that students were utilizing.”

Students on the Drug Abuse Awareness Team go to health fairs and pharmacies hosting drug take-back events to educate the public on proper medication disposal. Students also give medication disposal bags as a wraparound service for people who did not bring medications with them but want to discard them safely. “From a state perspective, these safe disposal bags have made a big impact on how we can manage smaller amounts of drugs taken back while waiting for biannual drug take-back events,” Riccio said.

DAAT students are also trying to address the opioid epidemic by going upstream, continuing to educate the youth by visiting middle schools and high schools. “It takes a passionate group of students who want to make a difference,” Riccio said of drug take-back programs. “I attend a lot of meetings and I identify community partners, but when I really think about the success of our Drug Abuse Awareness Team, it started with students and students continue to carry the legacy forward. Without my students being passionate about it, it would not have sustained itself.”

Relationships are vital, too. Schools looking to start door-to-door drug takebacks must find that partner to connect them to senior living facilities. Local or national law enforcement is critical. Schools must research state requirements for proper disposal, find the available access points, plan ahead and line out the whole path toward action.

“[W]hen I really think about the success of our Drug Abuse Awareness Team, it started with students and students continue to carry the legacy forward. Without my students being passionate about it, it would not have sustained itself.”

— Dr. Krystal Riccio

Still, the biggest issue in getting rid of medications is convincing people that they’re unnecessary. “When you show up with drug take-back bags and you say they’re for disposal of medications like opioids, people laugh at you, like, ‘Why would I get rid of them?’” Riccio said. “So I say, ‘Let’s think about this a different way. I know you wouldn’t misuse your medications, but perhaps someone in your household or a visitor comes across it, that might be a temptation for them.’ That’s probably the biggest impact that we’ve had in the community— getting people to see that we’re not always in control of the medications in our medicine cabinets.”

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

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Introduction A Call to Action Strategies for Smarter Service Expanding Naloxone Awareness and Use Doubling Down on Drug Disposal Delivering Straight Talk on Opioids

Delivering Straight Talk on Opioids

A mobile clinic in Ohio and public opioid instruction in Florida are prompting conversations and making a difference in those communities.

By Joseph A. Cantlupe The Ohio Northern University Raabe College of Pharmacy sits on nearly 342 acres in Ada, seemingly the epitome of a quaint small town. The college has been a continual presence in the community, founded in 1884 and graduating thousands of pharmacists over the years. But the community of 6,000 around the campus has been severely struck by the opioid crisis gripping the nation. The area has a mean income of $35,000, with significant poverty and a lack of access to healthcare. Ada has one physician and no specialists.

More than three years ago, Dr. Amy Fanous, assistant clinical professor at the college, wanted to show the community what pharmacists can do to help them. She jumped in her Ford Fusion and rambled around, going to churches and schools and neighborhood centers. She took patients’ blood pressure and told residents about preventative health management.

“Amy threw stuff in the back of her car and drove around,” recalled Dr. Steve Martin, dean of the Raabe College of Pharmacy. “She opened an access point.” In 2015, the school received a federal grant, and through donations, it bought a motor coach, dubbed the ONU HealthWise Mobile Clinic. “The original idea was to meet some of the health needs of the community, such as preventative education and management of chronic disease,” Martin recalled.

A switch turned on, too. They began addressing behavioral health and substance abuse issues, including the opioid crisis, which could not be ignored. Student pharmacists became part of the team that roamed the community in the mobile unit, spreading the word about the importance as well as the dangers of drugs and ways people can improve their health. “It opened the door from the opioid perspective,” added Dr. Michael Rush, director of ONU HealthWise.

Around the country, pharmacy schools are enlisting students to become involved as part of their growing effort to demonstrate how pharmacists can help people avoid misuse and abuse of opioids and educate patients about safe and appropriate access to the drugs. Nearly 900 miles away, the University of Florida College of Pharmacy has included students as volunteers to help teach the community about opioid safety issues. Student pharmacists talk with residents about the signs of opioid misuse and discuss proper drug storage, the best way to dispose of medications and how naloxone can reverse opioid overdoses.

Student pharmacists now comprise at least a third of the program’s community trainers, who have served 1,000 people since August 2017, said Dr. Carol Anne

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Motycka, the assistant dean, campus director and clinical associate professor who originated the program. Bringing student pharmacists into the community has long been part of Motycka’s instruction, whether it’s going to the crime laboratories or drug courts “and letting them see what people are dealing with.”

ONU’s Dr. Amy Fanous wanted to show the community what pharmacists could do for them. Her efforts led to the ONU HealthWise Mobile Clinic.

The opioid issue brought home the need to step up instruction surrounding substance abuse and pharmacists’ role in the community, said Motycka. “We’ve always tried to do some training, but honestly it hasn’t been the big issue that it is now. The last several years we really ramped it up.” Motycka is also co-chair of the Heroin and Opioid Task Force, which is part of a Duval County community organization named Drug Free Duval where she works with community partners to deal with substance abuse issues.

The training is now considered part of the curriculum, and students volunteer and then help train people in the community “not only about all the signs of misuse and the red flags about opioids, but how you can help people” with screenings, interventions and referrals for treatment, she said.

It’s one thing to talk academically about the drug usage problems; it’s another to see it firsthand. “I think all of us live in a little world of our own,” she added. “We don’t get to see some of the stuff that’s going on. You might hear about it with the media but you need to actually talk to the folks dealing with this stuff. As pharmacists, we are one of the more accessible providers in healthcare.”

A Wake-Up Call in Ohio In Ada, the local media described the community as a breeding ground for opioid use. The numbers from the courthouse told the story: Five years ago, the courts counted zero opioid-related cases. Now, non-prescription opioids account for 21 percent of cases, the media reported.

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ONU’s mobile clinic has averaged 400 healthcare events annually and gives students an opportunity to interact with patients.

“We’re in a community where opioid use, heroin use is a big deal,” Martin said. ”You wouldn’t think of it in a sleepy town like Ada, but it is, it definitely is. We’ve been watching this whole thing unfold over the course of several years. And we have a tool that might be able to address some of the needs in the area. We have a community that needs this assistance, and part of our mission is community engagement. From the get-go, the whole idea was to bring access to the healthcare system for our community.”

Students are an integral part of the teams in the mobile clinic, under the supervision of a licensed professional. At least two pharmacy students occupy the mobile unit at a time. They go out from one to five days a week, said Fanous, now director of the ONU HealthWise Mobile Clinic. Sometimes they go to a parking lot, stay there and meet local residents. Sometimes they go to food pantries and win over local residents by helping them clean dishes or carry food. “It’s become a key component of the education we are providing the students,” Rush noted.

Making inroads into helping patients in their everyday care is part of the mobile clinic’s role, including addressing some issues that are not often discussed, such as proper medication disposal. In Hardin County, where Ada sits, not many medication disposal sites exist and some people might be reluctant to use the program run by the sheriff’s department, Rush said. To alleviate that problem, the mobile clinic provides patients with bags to discard their old medications to deactivate the drugs. “We don’t have to worry about the drugs getting into the wrong hands.

It’s a critical piece of the puzzle,” Rush said.

For many people, opioid use is linked to their struggles with overcoming and managing pain. With the mobile clinic, students “have the opportunity to talk

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to patients about how to manage pain, how to use medicine to control pain and other non-medication strategies to control pain,” Martin pointed out. “That’s an important piece for us. It’s important we’re talking about their use of prescription drugs. No one wants to be addicted to pain medication, but we make people aware that’s a possibility and help them manage through controlling pain in an appropriate way. Those are solutions that we as pharmacists can provide anywhere.”

University of Florida pharmacy faculty participate in a training on drug overdose prevention practices.

The mobile clinic’s many roads through the community are “eye-openers” for the students. Becoming involved and watching the discussions has a profound impact.

They see the quizzical looks from the residents and the uncertainty about their health. Fanous talked about how one resident had high blood glucose but it didn’t affect him until he mentioned he had trouble seeing. That raised alarms within the mobile unit and the team worked to get him follow-up care for diabetes. “For some individuals, this is the only access he or she may have to healthcare,” said student pharmacist Megan Stephan.

The mobile clinic is putting on the miles, partnering with the local health center, the health department and the critical access hospital in the area, Hardin Memorial Hospital. The clinic has averaged 400 healthcare events annually. At least 27 percent of patients return for follow-up visits. According to the college, at least 47 percent of patients had abnormal clinical findings and about 17 percent of patients were referred to a physician for care management, including acute care concerns.

Student pharmacist Clayton Miller said he has witnessed amazing moments.

“Simply even talking to a patient that comes into the mobile clinic or even letting them know their blood pressure is a little bit high might be the one step that prevents them from having a serious medical-related event that could be fatal.”

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Left: A Raabe College of Pharmacy student pharmacist performs a blood pressure check on a patient.

Right: Florida’s Dr. Carol Anne Motycka said students play an important role in educating the community about opioid safety.

Sparking Conversations in the Sunshine State The Jacksonville, Florida, area has been particularly hard hit by opioid problems. In 2017, the Jacksonville Fire and Rescue Department handled 3,460 overdose calls, an average of 308 per month, according to department records. At least 10 percent of overdose calls in 2017 were repeat occurrences. And 2 percent of those patients with repeat occurrences had them 10 or more times.

Residents in the community ask questions about drug use and the trainers then check afterward to ask how much they learned. Many people lack understanding about the intricacies of opioids. For instance, many don’t realize that heroin is an opioid and it can be taken orally or smoked, Motycka said.

The student pharmacists review the many elements of opioids with the residents. “It’s incredible in general how little knowledge is out there before [they are] trained,” she noted.

With the city and nearby communities battling opioid issues, the University of Florida pharmacy program revamped its training modules in the curriculum related to opioid instruction. Students who volunteer discussing opioids in the community may receive instruction and can become trainers themselves, accompanied by academic supervisors. During the training, they teach the community how to screen and provide interventions in locations such as homeless shelters or at facilities for foster parents and then provide referrals for treatment if needed. At least one-third of the trainers— about 50 so far—have been students.

The sessions are a big draw for the students. “Honestly, they do it on their own time but they love it and even say it’s an amazing experience, they’ll do it again.” Student pharmacist Ekaterina Nichols volunteered to discuss pharmacological issues at the local homeless shelter and the experience humbled her. When they distributed and discussed the material, Nichols was at first worried about how people would accept the material. “To my surprise the public was very receptive and forthcoming,” Nichols said. Not only that, many people asked for more information or where they could get assistance if a loved one or relative fell victim to opioid abuse. They also sought more information about ways to combat opioid abuse.

The student pharmacists also quiz people involved in helping patients deal with opioids and talk with high school and middle school students about the drugs. They discuss the dangers of “pharm parties,” where people give drugs to partygoers, who may not know what they are taking. To demonstrate, they hand out bags of different colored Skittles representing various pills. Ensuing confusion shows the students how easily trouble comes.

“This teaching experience was of paramount importance to me as a future pharmacist because it underlined the public need for education on opioid-related issues,” Nichols said. ”I felt that my teaching was extremely helpful to the public.

Most important, it gave me the opportunity to interact with a vulnerable population whose needs are often overlooked. The experience was humbling and I would gladly repeat it again.”

“So you took the blue one and the red one, now what’s going to happen because of the interaction?” Motycka said, recounting the exchanges. The student pharmacists “talk to the high school students and it hits home with them. They do a better job than I do when they go to schools. The students really listen to them because they are closer in age,” Motycka said. “You can talk until you are blue in the face but without showing them, it doesn’t make much of an impact.”

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As Motycka examines her program, she is hopeful that their efforts are making an impact in the area. “Hopefully once [the students] are pharmacists, they are going to continue doing this,” she said. “One of the things we emphasize is that we can make a huge difference in the community.” P Joseph A. Cantlupe is a freelance writer based in Washington, D.C.

community impact

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A Reinvented Portrait of the Pharmacist Pharmacists joined voices to change perceptions and brainstorm strategies to transform the practice at INvolve 2019.

By Athena Ponushis Academic pharmacists’ perpetual endeavor to aim higher was palpable in the presentations and conversations at INvolve 2019, the AACP Interim Meeting in Tampa, Fla., in February. The desire to better showcase who pharmacists are and what they can do informed the discussions. Dr. Damon Williams, chief catalyst at the Center for Strategic Diversity Leadership and Social Innovation, kicked off the conference speaking about how diversity takes courage. He focused on the courage to innovate, make faculty diversity a true priority, create meaningful pre-pharmacy bridge programs, commit dollars to the strategy and train the profession to be inclusive and make strategic moves.

“The way we increase the likelihood of making a diverse faculty hire is to increase the likelihood of making a diverse faculty hire, meaning we will search until our interview slate is diverse,” Williams said. “It’s about how we think about who

we select to be the next cohort of Pharm.D. candidates. Do those individuals all have to have a recalculated GPA of 3.8 and above or could they maybe get by with a 3.3 and a whole bunch of grit and resilience and culturally relevant desires?

That’s where we can grow, it’s those conversations, it’s taking something that’s not a qualified part of our selection matrix and making it a qualified part of our selection matrix, and that takes courage.”

As the former senior vice president and chief education officer at the Boys & Girls Clubs of America, Williams led the Great Futures Campaign for Impact, which he sees as his way of making ripples in the world. To attract a diverse talent pool, enrich the pipeline and reshape the portrait of a pharmacist, Williams suggested schools launch initiatives for middle- and high-school students, allowing them to try on that possible self of becoming a pharmacist.

“To reposition the image of a diverse pharmacist, you’ve got to understand, from the perspective of those diverse communities, what’s going to resonate with them,” Williams said.

“Connect the pharmacy career path to that notion of your passion, your purpose and your why. ‘Pharmacists work in diverse communities, so you are going to be able to give back to your community. Pharmacists have to answer questions that are technical in nature but must be able to interface with people everyday. Pharmacists are able to live a lifestyle of economic freedom.’ Those are big things.”

Dr. Ola Ghoneim, University of Saint Joseph School of Pharmacy and Physician Assistant Studies, walks session attendees through research experiences for students in an accelerated Pharm.D. program. “When a research course is only one week long, it seems more achievable and gets more students excited to engage,” she summarizes.

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“Change the conversation, first from a negative to a positive, listen to those individuals in your organization who might currently be feeling like they’re not being heard because you’ve boxed them into some generational pigeonhole and look for an opportunity to bond across shared vision and goals.”

— Dr. Willette Burnham-Williams

Williams shared a lesson he learned from Rep. Donna Shalala, who formerly served as U.S. Secretary of Health and Human Services and as president of the University of Miami. When Shalala first arrived in Coral Gables, she looked around and saw students commuting but did not see students on campus having conversations. “She knew she needed to work on a bigger strategy and committed to that, but what she immediately did, she said, ‘I put the lawn chairs on the lawn,’” Williams said. “So I say to you, what are the lawn-chair moves you can make to advance this work today?”

Finding Harmony in Diversity

As far as strategies to bring generations closer together, Burnham-Williams believes in cross-generational mentoring, being sensitive to each generation’s idea of fairness and values and remembering that change happens one conversation at a time. “If you hear someone refer to students as slackers, say, ‘Stop,’” she said. “Say, ‘I understand we have our differences, but our role is focused on their successes and you cannot make them successes if you approach them as slackers.’”

Dr. Richanne Mankey, president of Defiance College and a mediator, finds herself taking a deep breath in the middle of such conversations, which is how she opened her keynote address. She shared her perspective on effective ways to engage employees to consciously develop a positive culture.

Defining morale as how campus feels and culture as how staff live and work together, Mankey shared a Peter Drucker quote: “Culture eats strategy for breakfast.”

Dr. Willette Burnham-Williams, assistant professor, university chief diversity officer and Title IX coordinator at the Medical University of South Carolina, addressed generational differences in the workplace. She had the youngest member of her team review her presentation before the conference. He told her to change the title, pointing out that “When I came to Defiance College [as the first female presithe conversation was about an intersection of generations, dent], the board of trustees wanted to hand me a strategic not a collision, and that it was about inclusion. So she did not plan,” she said. “I asked them to please not hand me a stratespend much time defining generations by their differences, gic plan, I thought it needed to be reviewed by me and have but instead looked for common ground. my touch on it.” The board agreed and Mankey was able to present a plan that reflected her campus and her vision. She Burnham-Williams reflected on the strengths each generation can contribute and the need to change divisive language. used this story to speak to servant leadership.

She encouraged leaders to look through another person’s lens and to steer conversations to what colleagues might share. “Change the conversation, first from a negative to a positive, listen to those individuals in your organization who might currently be feeling like they’re not being heard because you’ve boxed them into some generational pigeonhole and look for an opportunity to bond across shared vision and goals,” she said.

Before she took her strategic plan back to the board, she unveiled it to campus. Her staff said that was dangerous and questioned what would happen if people didn’t like it. Mankey replied, “Well, we need to know that.” So she held sessions in the coffee shop for faculty to share their thoughts.

“Engaging other folks, bringing people to the table, knowing where the decision lies but engaging in the conversations that lead up to that decision” is how Mankey balances servant leadership with vision.

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“We need to move from interprofessional education, which is a focus we have had for a number of years, to interprofessional practice.”

— Dr. Todd Sorensen Mankey noted other leadership traits she tries to demonstrate: listening to understand, not to respond; leading with a big “L” (your leadership position) and a little “l” (your perspective and values); and finding ways other than shame to motivate. She acknowledged that transformational change requires vision and it’s hard to do, but encouraged everyone to do it anyway. She offered the inspiring words of scholar and activist Angela Davis: “I am no longer accepting the things I cannot change, I am changing the things I cannot accept.”

Voicing the Value of Pharmacists As the Pharmacists for Healthier Lives campaign builds a strong national network to help elevate the perception of pharmacists and get their voices heard in the media, AACP asked attendees to share stories that merit attention. Pharmacists stood up and shared stories of student-run pharmacies; faculty members featured on the local news; students participating in state preparedness training; efforts to

emphasize the accessibility of pharmacists for vaccinations; and bringing telepharmacy to towns that did not have access to healthcare.

Then attendees were asked to recall moments when a pharmacist impacted someone’s life. One dean talked about a clinical trial where gene therapy helped a patient who had been disabled by back pain for years. He was featured in the cover story of the college magazine, photographed on a playground with his children, illustrating that pharmacists do research that can change lives. Another told the story of a patient complaining of a cough/cold, but a student pharmacist asked questions and decided to send the patient to the emergency room, where the patient had a pulmonary embolism. Another shared the story of a student who was eating lunch on rotation at the hospital when he performed the Heimlich maneuver and saved a man choking at the table next to him. (Members who would like to share stories can post them on PharmacistsForHealthierLives.org to add them to the campaign network.)

President-elect Dr. Todd Sorensen gave a sneak peek of what to expect under his leadership by contrasting two stories.

First, he recalled a meeting with behavioral health professionals to potentially partner, increase access to care and create sustainable practices. None of them had a meaningful relationship with a pharmacist and they lacked understanding of pharmacy training, so they could not see how the two groups could support each other and approach the legislature in a way that would benefit state residents. Next, he recalled

Left: AACP President Dr. David D. Allen addresses the attendees at the Town Hall, hosting the event, and detailing the progress of the AACP-led Pharmacists for Healthier Lives campaign.

Above: NACDS Foundation Manager of Pharmacy Programs Dr. Kayla McFeely enumerates the projects in which the NACDS Foundation is supporting colleges of pharmacy.

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introducing himself to the president-elect of the Minnesota Academy of Family Physicians, who immediately said, “It’s great to meet you. I will never work in a clinic again that does not have a pharmacist in it.”

“Why the difference? What’s going on there? What does that mean for us?” asked Sorensen, who plans to focus on AACP Strategic Priority 3, to promote academic practice partnerships and involve pharmacists in practice models that lead to progress in practice transformation. “We need to move from interprofessional education, which is a focus we have had for a number of years, to interprofessional practice,” he said.

He asked attendees to imagine a world where every medical practice has meaningful relationships with pharmacists, built on trust and respect. “I envision that,” Sorensen said. “Patients’ health would improve. We would create powerful advocates that would tell our story for us. We would create a new job market that doesn’t exist right now, or only exists in small pockets. And we would enrich the lives of our graduates in a professionally meaningful role that they would aspire to, and encourage others to join our pipeline and pursue a career as a pharmacist.” P

“To reposition the image of a diverse pharmacist, you’ve got to understand, from the perspective of those diverse communities, what’s going to resonate with them. Connect the pharmacy career path to that notion of your passion, your purpose and your why.”

— Dr. Damon Williams

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

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#PharmEd19: Put Your Career First in the Second City

Connect with colleagues in Chicago and learn from experts in leadership, education and science, including keynote speaker and Pulitzer Prizewinning historian Dr. Doris Kearns Goodwin.

Register for the meeting before the early-bird deadline of Friday, May 17, and save more than $100! Visit www.aacp.org/ article/pharmacy-education-2019-registration-rates for details.

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Choose Chicago Visit www.aacp.org/PharmEd19 to reserve your room at the Hyatt Regency Chicago, before exploring all the city has to offer at www.ChooseChicago.com

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A New Way to “Connect” with the Academy AACP Connect, the online membership community, is launching Volunteer Opportunities, a new space to find ways to volunteer with committees, at events and within programs at AACP and around the Academy. Initial offerings include monitoring sessions and judging trainee posters at Pharmacy Education 2019, July 13–17, in Chicago, with new opportunities added continually throughout the year.

AACP will begin accepting opportunities from Section and SIG chairs starting in the fall.

For further information and opportunities, visit https://connect.aacp.org/volunteeropportunities or contact Matt Cipriani, knowledge management & member engagement manager, at mcipriani@aacp.org.