North Carolina Pharmacist Volume 107 Number 3

North Carolina Pharmacist Volume 107 Number 3

Advancing Pharmacy. Improving Health.

Inside This Issue: Opioid Use Disorder: A Chronic Disease with Persistent Barriers to Care Opioid Overdose Awareness: Impact of College Campus Education NCAP News with Convention Highlights

Official Journal Of The North Carolina Association Of Pharmacists ncpharmacists.org

Official Journal of the North Carolina Association of Pharmacists PO Box 58 36 Court Square, SW Graham, NC 27253 Phone: (984) 439-1646

North Carolina Pharmacist

www.ncpharmacists.org EDITOR-IN-CHIEF Tina Thornhill

Volume 107 Number 3

A Few Things Inside

LAYOUT/DESIGN Rhonda Horner-Davis EDITORIAL BOARD MEMBERS Anna Armstrong Jamie Brown Lisa Dinkins Jean Douglas Brock Harris Amy Holmes John Kessler Angela Livingood Scott Perkins Bill Taylor

• From the NCAP Executive Director........................................................................4 • Opioid Use Disorder: A Chronic Disease with Persistent Barriers to Care.................7 • Pharmacy Resident-Run GLP-1 Titration Clinic in Cardiology...............................12 • Opioid Overdose Awareness: Impact of College Campus Education......................17

BOARD OF DIRECTORS

• Impact of Pharmacy Licensure Changes on Prescription Volume.............................27

EXECUTIVE DIRECTOR Penny Shelton

• Member Spotlight...............................................................................................31

PRESIDENT Leigh Foushee

• NCAP News with Convention Highlights..............................................................34

PRESIDENT-ELECT Angela Livingood PAST PRESIDENT Tom D’Andrea TREASURER Ryan Mills SECRETARY Macary Marciniak Zach Carver, Chair, SPF Anna Brown Everhart, Chair, NPF Christine Heath, Chair, Community Sacha Pollard Deloney, Chair, Health-System Tasha Woodall, Chair, Chronic Care Ben Smith, Chair, Ambulatory Leslie Barefoot, At-Large Miranda Hill, At-Large Trent Beach, At-Large North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists. An electronic version is published quarterly. The journal is provided to NCAP members through allocation of annual dues. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement. Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher.

North Carolina Pharmacist is Supported in Part by: • PMC Advantage Insurance Services .........................................................6 • Alliance For Patient Medication Safety ..................................................10 • Pharmacy Technician Certification Board (PTCB) ................................11 • NCAP Career Center ..............................................................................16 • Pharmacy Quality Commitment .............................................................26 • Working Advantage.................................................................................33 CORRECTIONS AND ADVERTISING For rates and deadline information, please contact Rhonda Horner-Davis at rhonda@ncpharmacists.org

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•From the Executive Director• Penny S. Shelton, PharmD, FASCP, FNCAP

The “Let Them” Theory, Through a Pharmacy Lens

Lately, my podcast queue has been full of conversations about Mel Robbins and her runaway bestseller, “The Let Them Theory.” If you haven’t encountered it yet, you likely will soon — it has become one of those ideas, like a hit song, that you start hearing everywhere once you notice it. The premise is disarmingly simple. Robbins argues that so much of our stress comes from trying to manage things we were never built to control: other people’s opinions, choices, moods, and behavior. Her fix is a two-word mantra. When someone disappoints you, excludes you, or simply insists on doing things their own way — Let Them. Redirect that same energy inward with its companion phrase, Let Me: Let me decide how I respond. Let me decide what I do next. Research she cites suggests a striking number of us — something like seven in ten people — live in a low hum of chronic stress from trying to steer people who were never ours to steer. Released from that effort, she argues, we get our peace back.

to value what we value. Some portion of our exhaustion really is self-inflicted, spent white-knuckling outcomes that belong to someone else. I don’t fault anyone for finding relief in those two words.

But I have found myself testing this theory against a very different backdrop: the profession I have spent my career serving. And here, I think, “Let Them” becomes harmful. Pharmacy is not simply a collection of individuals each managing their own careers. It is a self-governing profession, licensed and entrusted by the public, and that license comes with a duty that extends beyond any one practice, any one pharmacy, any one career. We are, collectively, the stewards of what pharmacy is allowed to be — what scope we practice to, what we are paid for the care we provide, and what the next generation inherits when they take the oath after us. That stewardship does not run on autopilot, and it certainly does not succeed if we each retreat into our own “let them” corner. It runs on people showing up.

I made this same argument, in a I understand the appeal. In our different light, a couple of years personal lives, there is real wis- ago after a panel discussion at dom here. We cannot make an a national pharmacy education adult family member choose dif- conference, where I described ferently. We cannot force a friend something I called the profession’s “self-harm cycle” — the Page 4

pattern that emerges when the vast majority chooses, and yes, it is a choice, to be disengaged from the work it takes to be caretakers of our profession.

We need a pharmacy version of an ancient trireme — a warship built for dozens of oars pulling together — not a fleet of individual dinghies each rowing their own direction. Can we really afford, as a profession, to simply “Let Them” not join, “Let Them” sit this one out, “Let Them” assume someone else is handling it?

Of late, I have been working with our staff and nominating committee on vetting candidates to run for Association office, and one candidate told me that, through the years, our inaction and unwillingness to work together have in part created most of the challenges we face today. I had to agree — through the decades, because our profession was not as tightly organized as others, this did indeed contribute to the erosion we’re living through now: compressed reimbursement, practice authority that lags miles behind our training, and a public that still isn’t sure what a pharmacist is actually capable of. In Robbins’ book, she doesn’t just leave “Let Them” as a purely passive stance — there’s a companion leadership chapter aimed at teams and organizations. But even there, the emphasis is on protect-

ing your own energy from other people’s drama and opinions, not on whether a licensed profession has an obligation to organize on its own behalf. Those are different questions. You can master your own peace of mind and still owe your profession something more than a shrug and a “Let Them.”

we should be just as cautious with our profession.

New Practitioner Forum hosted a book club discussion on Let Them. The event was open to all members who wanted to join. Whether participants were early adopters of Let Them or were just discovering the theory, the discussion provided an opportunity to learn more about putting it into practice and to debate its merits and caveats.

Theodore Roosevelt once said, “Every [individual] owes a part of [their] time and money to the business or industry in which [they are] engaged. No [individual] has the moral right to withhold [their] support from an organization that is striving to improve conditions within [their] sphere.” If you take nothing else from this column, take this. We cannot fix the problems we face as a profes- Pharmacy Proud, sion by “Let them not join,” “Let them remain uninformed,” “Let them not help.” When it comes to the profession that all of us Penny borrowed our livelihoods from, I don’t think we get to let each other drift and call it wisdom.

In fairness to Robbins, she is not writing about professional associations or scope-of-practice fights; she’s writing about personal peace, and on that front, living by a “Let Them” mantra is very freeing. But self-help theories — particularly ones that catch on like wildfire — have a way of leaking out past their original borders, and I’d rather get ahead of that leak than clean up after it. We religiously abide by taking actions that do no harm to our patients; On September 29 at 6 p.m., the

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Opioid Use Disorder: A Chronic Disease with Persistent Barriers to Care By: Victoria Wilk, PharmD Candidate 2027, Dr. Mina Wolfe, PharmD, and Dr. Cheryl Viracola, PharmD

Between 1999 and 2023, an estimated 806,000 people in the United States died from an opioid overdose, involving both prescription and illegal opioid use (1). More than 35,000 of those deaths occurred in North Carolina. In 2024 alone, eight people in North Carolina died every day from a drug overdose, and preliminary 2025 data suggest that this trend has not improved (2). Opioid use disorder (OUD) is a chronic brain disease characterized by dopamine deficiency and consequent neuroadaptations that reinforce the risky behaviors related to acquiring and ingesting opioids that are commonly observed in patients with OUD (3). The adaptations that occur in response to the brain’s dysregulated reward system do not simply resolve following the discontinuation of opioid use. Abrupt cessation of opioids disrupts physiologic homeostasis because of the sharp decline in opioid concentrations and leads to physical symptoms like sweating, insomnia, agitation, and pain (3). As a result, patients experience an increased

compulsion to use opioids again to relieve their withdrawal symptoms and satisfy intense cravings (3). In addition, chronic opioid use reduces the sensitivity of the brain’s reward system, which decreases the pleasure derived from inherently rewarding stimuli such as food and social interactions (3).

to stigma among healthcare professionals. Stigma can occur across the healthcare system, including medical practices, hospitals, and community pharmacies. Individuals with OUD may experience stigma in very practical ways. It may be obvious, such as judgmental language, refusal to provide a service, or difficulty obtaining medications preThese physiologic changes help ex- scribed to treat OUD. It may also be plain why OUD is a chronic medi- more subtle, such as having sympcal condition that can be difficult toms or concerns dismissed, ento manage without appropriate countering unnecessary barriers to treatment and ongoing support. treatment, or simply being made to Although effective, evidence-based feel unwelcome. treatments for OUD are available, the complex nature of the disease In the pharmacy setting, patients is only one challenge patients face. may encounter reluctance or reStigma and other barriers with- fusal to dispense medications for in the healthcare system can also OUD, creating an additional barrimake it difficult for patients to er even after treatment has been seek, receive, and remain engaged prescribed. These experiences can in treatment. make patients less likely to disclose opioid use, ask for help, seek Stigma as a Barrier to Treatment treatment, or return for follow-up care. The consequences can be Limited training, unfamiliarity with significant. When patients expect OUD treatment, administrative or experience judgment from the burdens, and negative perceptions healthcare system, they may delay of people with OUD can contribute or avoid seeking treatment altoPage 7

gether. For a person with OUD, that can mean continued opioid use, missed opportunities to begin or remain in treatment, and increased risk of overdose and death (4). Reducing stigma requires a shared healthcare response. Physicians, pharmacists, nurses, and other healthcare professionals each have opportunities to create welcoming pathways into treatment. By working collaboratively and connecting patients to care at multiple points within the healthcare system, the healthcare team can reduce barriers, improve treatment engagement, and help patients remain connected to care.

for OUD. Under the former system, clinicians had to complete additional training and registration, were limited in the number of patients they could treat with buprenorphine, and only certain healthcare disciplines were eligible to obtain the waiver (5). The MAT Act removed these requirements and broadened federal eligibility to licensed practitioners, except veterinarians, with the appropriate DEA registration, provided they are authorized to prescribe under state law. The change also simplified the dispensing process by eliminating the need for pharmacists to verify a prescriber’s X-waiver status before dispensing buprenorphine for OUD.

Stigma, however, is not the only barrier to OUD treatment. Historically, federal regulatory requirements also limited which healthcare professionals could provide certain forms of OUD treatment and how many patients they could treat. Even as healthcare professionals work to reduce stigma and improve the patient experience, expanding access also requires removing unnecessary structural barriers and making better use of the healthcare workforce. Recent federal reforms have begun to address these limitations, creating new opportunities for qualified healthcare professionals to participate in evidence-based OUD treatment.

capacity. Clinicians may still face challenges related to training, experience, practice resources, and comfort with managing OUD. One survey of outpatient providers in Ohio found that clinicians who had previously obtained an X-waiver reported greater confidence in prescribing buprenorphine and demonstrated lower levels of bias toward patients with OUD than clinicians who had not obtained a waiver (7). These findings highlight the continued importance of education and clinical experience even as regulatory barriers to treatment are removed. Recognizing the need to prepare healthcare professionals for this evolving model of care, the North Carolina Association of Pharmacists (NCAP) developed an eight-hour, certificate-level OUD training program designed to meet MATE Act educational standards. The program was intentionally built around an integrated, interprofessional model of care that incorporates perspectives from multiple healthcare disciplines and emphasizes their complementary roles in OUD treatment. In this way, the training goes beyond satisfying a federal educational requirement by helping clinicians understand how they can work together to identify, treat, and support individuals with OUD.

The Medication Access and Training Expansion (MATE) Act, enacted alongside the MAT Act reforms, addressed education more broadly. Rather than requiring specialized training only from clinicians seeking authorization to prescribe buprenorphine, the MATE Act established a one-time substance use disorder training requirement for most practitioners applying for or renewing a DEA registration (6). Together, the MAT and MATE Acts shifted federal policy away from a separate regulatory pathway for buprenorphine prescribing while establishing a broader expectation for substance use disorder education across the DEA-registered prescribing workforce. Community Pharmacy as an ExtenRemoving Regulatory Barriers to sion of the Treatment Team OUD Treatment Building an Interprofessional OUD Workforce More than 95% of Americans live Federal Reform: The MAT and MATE within 10 miles of a community Acts While these reforms have expand- pharmacy, providing pharmacists ed the number of healthcare pro- with frequent opportunities to enIn 2023, the Mainstreaming Addic- fessionals who may participate gage with patients and collaborate tion Treatment (MAT) Act eliminated in OUD treatment, expanded au- with other members of the healththe federal X-waiver previously re- thority alone does not necessarily care team (8). For patients with quired to prescribe buprenorphine translate into expanded treatment OUD who may benefit from ongoing Page 8

medication management, assessment, and follow-up, incorporating community-based pharmacists into the care team can create additional points of access while extending the reach and capacity of OUD treatment providers. Evidence also suggests that patients are receptive to this approach. In one study evaluating a physician-pharmacist collaborative model for buprenorphine treatment, treatment retention and adherence at six months were 88.7% and 95.3%, respectively (9). Among the 71 participating patients, more than 90% reported satisfaction with the collaborative model, with convenience associated with receiving buprenorphine-related care at the pharmacy where their medication was dispensed contributing to that satisfaction (9). Long-Acting Injectable Buprenorphine: Putting Collaboration into Practice Long-acting injectable buprenorphine (LAI-B) provides an opportunity to translate this collaborative model into practice. Buprenorphine is an evidence-based medication for OUD that can reduce opioid cravings and withdrawal symptoms and help patients remain engaged in treatment. As a partial agonist with high affinity for the mu-opioid receptor, buprenorphine provides sufficient receptor activity to reduce withdrawal and cravings while producing less opioid effect than full agonists. Its pharmacologic properties contribute to a favorable safety profile, including a lower risk of respiratory depression than full opioid agonists (10).

providing sustained medication delivery through weekly or monthly formulations. For appropriate patients, LAI-B can reduce the need for daily medication administration, provide consistent therapeutic exposure, and create another option for maintaining continuity of OUD treatment. Since October 2021, qualified immunizing pharmacists have been authorized to administer long-acting injectable medications to adults pursuant to a prescription from an authorized prescriber. This authority allows eligible patients prescribed LAI-B to receive their injections from a participating pharmacist in the community rather than relying solely on the prescribing practice for administration. The significance of this authority extends beyond simply providing another location for an injection. A prescriber can identify a patient who may benefit from LAI-B and collaborate with a pharmacist who can help facilitate medication access and provide ongoing administration closer to where the patient lives. With appropriate communication between the pharmacist and prescriber, this model can create additional touchpoints with the patient, support continuity of treatment, and reduce the burden on practices that may not have the staffing or infrastructure to provide recurring injections.

CPP scope to allow physicians to delegate health care services through a collaborative practice agreement (CPA), including functions related to drug therapy, disease, and population health management. Depending on the services delegated within the CPA, a CPP may initiate, change, or discontinue medications and order tests or devices as part of the patient’s care (11). For OUD treatment, these authorities create the potential for a more integrated physician-pharmacist model. Rather than functioning solely as the site where an LAI-B injection is administered, a CPP practicing under an appropriately structured CPA could take a more active role in helping manage suitable patients, while the collaborating physician maintains oversight as required under North Carolina law. This creates an opportunity to distribute components of ongoing OUD care across the healthcare team and expand community-based access. Moving from Opportunity to Practice

Federal and North Carolina policy reforms have created new opportunities for pharmacists to contribute to OUD treatment, while the accessibility of community pharmacies provides an important platform for extending evidence-based care into the communities where patients From Administration to Collabora- live. tive Management Recognizing this opportunity, NCAP More recent changes to North Car- is working to expand community olina’s Clinical Pharmacist Prac- pharmacy capacity to provide LAI-B titioner (CPP) framework create services across the state. While inopportunities to take this collabora- creasing access to LAI-B administration even further. Effective October tion is an important first step, the LAI-B extends these benefits by 1, 2025, state law broadened the broader vision extends beyond the Page 9

injection itself. By fostering stronger relationships between pharmacists and OUD treatment providers, community pharmacies can become an extension of the treatment team. As pharmacist authority and collaborative practice opportunities continue to evolve in North Carolina, LAI-B offers a practical model for demonstrating how physicians and pharmacists can use their complementary expertise to expand treatment capacity. NCAP’s efforts represent an important step toward translating these policy opportunities into an integrated, team-based approach to OUD care—one that brings treatment closer to the patients and communities that need it. Authors: Victoria Wilk is a 2027 PharmD Candidate at the UNC Eshelman School of Pharmacy in Chapel Hill, North Carolina. Mina Wolfe, PharmD, is the Grants Coordinator at the North Carolina Association of Pharmacists. Cheryl Viracola, PharmD, is the Director of Practice Advancement at the North Carolina Association of Pharmacists. References 1. CDC. Understanding the opioid overdose epidemic. Overdose Prevention. July 12, 2025. Accessed July 29, 2026. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic. html 2. North Carolina Overdose Epidemic Data. Division of Public Health. Accessed July 29, 2026. https://www. dph.ncdhhs.gov/programs-services/ chronic-disease-and-injury/injury-and-violence-prevention-branch/ north-carolina-overdose-epidemic-data 3. Substance Abuse and Mental Health Services Administration (US), Office of the Surgeon General (US). Facing Ad-

diction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Published online November 2016. 4. Cheetham A. The Impact of Stigma on People with Opioid Use Disorder, Opioid Treatment, and Policy. Substance Abuse and Rehabilitation. Published online January 25, 2022. 5. SAMHSA Substance Abuse and Mental Health Services Administration. Waiver Elimination (MAT Act). November 6, 2024. https://www.samhsa.gov/ substance-use/treatment/resources/ mat-act 6. Sokol R. After the MATE Act: Integrating Buprenorphine Prescribing Into Mainstream Family Medicine Education and Practice. Fam Med. 2024;56(2):74-75. doi:10.22454/ FamMed.2023.877215 7. Franz B, Dhanani LY, Hall OT, Brook DL, Simon JE, Miller WC. Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US. ProQuest. 2023. Accessed July 30, 2026. https://www.proquest.com/ openview/1a49c6e1bb5475692ffbb6ee4e4a1f2c/1?pq-origsite=gscholar&cbl=105462 8. Dear Colleague Letter on Expanding Access to Medications for Opioid Use Disorder Through Pharmacist State Scope-of- Practice Flexibility. The Administration for Children and Families. June 18, 2026. Accessed July 30, 2026. https://acf.gov/cb/policy-guidance/dcl-expanding-access-medications-opioid-disorders-pharmacist-flexibility 9. Wu LT, John WS, Ghitza UE, et al. Buprenorphine physician-pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network. Addiction (Abingdon, England). 2021;116(7):1805-1816. doi:10.1111/add.15353 10. Shulman M, Wai JM, Nunes EV. Buprenorphine Treatment for Opioid Use Disorder: An Overview. CNS Drugs. 2019;33(6):567-580. doi:10.1007/ s40263-019-00637-z 11. Campbell J. Guidance on Expanded Scope of Authority for Clinical Pharmacist Practitioners. Published online August 25, 2025. Page 10

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Implementation of a Pharmacy Resident-Run GLP-1 Agonist Titration Clinic in an Outpatient Cardiology Clinic

By: Dr. Sarah Crowell, Dr. Samantha Seivert, and Dr. Elena Wellen Introduction Glucagon-like peptide 1 (GLP-1) receptor agonists have cemented their place in therapy since their introduction to the market for the management of type 2 diabetes. They are now considered first-line therapy in adults with type two diabetes, and their use continues to expand to multiple indications. (1) Clinical trials such as SUSTAIN-6, REWIND, PIONEER-6, and LEADER have also established the role of GLP-1 receptor agonists in cardiovascular (CV) outcomes and mortality risk reduction in patients with diabetes. (2-5) Studies such as the STEP 1 trial and SURMOUNT-1 trial established the efficacy of GLP-1 receptor agonists for the treatment of obesity in patients without diabetes. (6-7) However, the SELECT trial was the first to show significant benefit of the GLP-1 receptor agonist semaglutide on CV outcomes in patients without diabetes, demonstrating a 20% reduction in the primary endpoint of a composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke. (8) These findings have expanded

the role of GLP-1 receptor agonists ceptor agonist titration. Conversely, in CV care. the frequency of GLP-1 receptor agonist titration may result in deAt Novant Health Heart and Vas- creased availability for other medcular Institute – Coastal Region ication management services of(Coastal HVI), Clinical Pharmacist fered by Coastal HVI CPPs. The goal Practitioners (CPPs) offer compre- of this quality improvement project hensive medication management was to determine the impact of a services for a range of CV condi- dedicated GLP-1 receptor agonist tions and medications. In recent titration clinic on the availability of years, the Coastal HVI CPP team Coastal HVI CPPs for further medihas received an increasing number cation management services. of referrals for the initiation and titration of GLP-1 receptor agonists. Methods Ideally, patients who begin a GLP-1 receptor agonist are seen every four This was a prospective, single-cenweeks for dosage titration. This en- ter, descriptive analysis that was sures safety and tolerability while IRB-exempt. The study took place facilitating timely dose titration to from December 1, 2025, through clinically beneficial doses. Howev- March 16, 2026, at Coastal HVI. Iner, the schedule templates for two clusion criteria included encounters select Coastal HVI CPPs only allow with patients of two select Coastal for a combined ten acute follow-up HVI CPPs referred to the GLP-1 reappointment slots per week, which ceptor agonist titration clinic during are used for any acute medication the study period. Exclusion criteria management services, including included encounters with patients GLP-1 receptor agonist titration. of the select Coastal HVI CPPs who The breadth of medication man- required follow-up for reasons othagement services requiring acute er than GLP-1 receptor agonist inifollow-up and limited CPP availabil- tiation/titration during the study ity may result in increased time be- period. The primary objective was tween appointments for GLP-1 re- to evaluate the effect of a dedicatPage 12

ed GLP-1 receptor agonist titration clinic on the number of CPP appointment openings that are available for other medication management services. This was measured through the primary endpoint of the number of GLP-1 receptor agonist titration appointments completed during the study period that saved CPP acute follow-up appointment openings for other services. Secondary objectives were to evaluate the effect of the clinic on the number of patients that reach maintenance doses of GLP-1 receptor agonists and the time taken to reach maintenance dose of GLP-1 receptor agonists. These were measured through the secondary endpoints of the percentage of patients that achieved maintenance doses of GLP-1 receptor agonists, the patients’ time to maintenance dose of GLP-1 receptor agonists, and the number of patients on each GLP-1 receptor agonist dose. The GLP-1 receptor agonist titration clinic operated on Monday afternoons each week. On each clinic day, up to 6 patients could be seen by the pharmacy resident, each with a thirty-minute telemedicine appointment. At these appointments, the patient’s GLP-1 receptor agonist dose was evaluated for efficacy and safety. Efficacy was assessed by evaluating the patient’s response in weight, blood glucose/ A1c (if applicable), and effects on appetite and diet. Safety was assessed by recording any adverse effects experienced by the patient due to the GLP-1 receptor agonist, including both gastrointestinal adverse effects and alterations in blood glucose. Depending on the patient’s response to the current dose of GLP-1 receptor agonist therapy, the medication dose was

adjusted as needed, and follow-up with the pharmacy resident was scheduled until the patient reached their maintenance dose. The maintenance dose of each patient’s GLP1 receptor agonist was defined as the maximally tolerated therapeutic dose that produced minimal to no adverse effects, which was not necessarily equivalent to the highest commercially available dose. After GLP-1 receptor agonist titration completion, patients were then deferred back to their primary Coastal HVI CPP for continued comprehensive medication management.

before patients could reach these doses. Patients who achieved their maintenance dose took an average of 8.4 weeks to reach this dose. Figure 1 describes the mean weeks to maintenance doses of GLP-1 receptor agonists evaluated in the study. Figures 2, 3, and 4 display the number of patients on each dose of GLP-1 receptor agonists at the conclusion of the study.

Discussion This study demonstrated the ability of a pharmacy resident to facilitate the progression to GLP-1 receptor agonist maintenance doses for Results most patients in just fifteen weeks of data collection. It also demonA total of twenty-five unique pa- strated a notable increase in the tients were seen across sixty-six ap- availability of CPP follow-up appointments in the GLP-1 receptor pointment slots for other medicaagonist titration clinic during the tion management services due to study period. Baseline character- the utilization of the GLP-1 recepistics are described in Table 1. On tor agonist titration clinic. By using

Table 1. Baseline Characteristics Table 1. Baseline Characteristics (n=25) Age, years, mean + SD 61.2 + 19.7 Male, n (%) 20 (80) Baseline weight, lbs., median (IQR) 215.8 (182-226) % Change in weight, mean -2.5% Baseline A1c, %, median (IQR) 6.3 (5.9-6.9) % Change in A1c, mean -0.4% average, patients completed 2.64 appointments with the pharmacy resident during the study period, and the pharmacy resident completed sixty-six appointments in total. Of the patients seen during the study period, fifteen (60%) achieved maintenance doses of GLP-1 receptor agonists at the study conclusion, while ten (40%) did not reach maintenance doses due to study completion occurring Page 13

the GLP-1 receptor agonist titration clinic led by the pharmacy resident, up to six patients per week were seen in the GLP-1 receptor agonist titration clinic rather than by their primary Coastal HVI CPP. This allowed the CPPs to utilize their acute follow-up appointment slots for other medication management services such as cardiac medication titration, follow-up after medication initiation, or other acute patient

concerns. A limitation of this study was the small sample size. Because this study evaluated only 25 unique patients across two CPPs, the data represent only a snapshot of the potential of the GLP-1 receptor agonist titration clinic. Additionally, the brief data collection timeframe did not capture all patients who participated in the clinic. Patients were able to enter and exit the study freely, which did not allow patients who were enrolled later in the study period adequate time to achieve their maintenance dose of their GLP-1 receptor agonist. This study also did not evaluate all GLP-1 receptor agonists that are commercially available at this time due to the limited sample size and lack of diversity in medications utilized. Thus, the data collected only evaluated patients receiving injectable semaglutide (Ozempic®), injectable semaglutide (Wegovy®), and tirzepatide (Mounjaro®). Of note, this study was completed prior to the FDA approval of oral semaglutide (Wegovy®) tablets and high-dose injectable semaglutide (Wegovy® HD). Overall, this quality improvement project illustrated the utility of a dedicated GLP-1 receptor agonist titration clinic in increasing Coastal HVI’s CPP acute appointment availability. Though the scope of this study was small, the concepts implemented by the clinic can be replicated and expanded to include additional clinic days, additional participating CPPs, and additional personnel gathering subjective information for the clinic such as pharmacy residents, medical assistants, or pharmacy technicians. Future directions should include these expanded aspects of the clinic to evaluate further the impact on achievement of maintenance GLP-1 receptor agonist doses and the increased schedule availability of CPPs. This quality improvement project highlights the utility and scalability of a dedicated GLP-1 receptor agonist titration clinic within the cardiology setting. Authors: (corresponding author) Sarah Crowell, PharmD, PGY1 Community-Based Pharmacy Resident, Novant Health New Hanover Regional Medical Center, Email: SCrowell01@novanthealth.org; Samantha Seivert, PharmD, BCPS, CPP, Novant Health Heart & Vascular Institute, Novant Health New Hanover Regional Medical Center; Elena Wellen, PharmD, BCCP, CPP, Novant Health Heart & Vascular Institute, Novant Health New Hanover Regional Medical Center Page 14

References 1.

2.

3.

Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 | Diabetes Care | American Diabetes Association. December 9, 2024. https://diabetesjournals. org/care/article/48/Supplement_1/ S181/157569/9-Pharmacologic-Approaches-to-Glycemic-Treatment. Marso SP. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine. 2016;375(19):1834-1844. doi:10.1056/NEJMoa1607141 Gerstein HC. et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomized placebo-controlled trial. The Lancet. 2019;394(10193):121130. https://doi.org/10.1016/S01406736(19)31149-3

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Husain M. Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine. 2019;381(9):841-851. doi:10.1056/NEJMoa1901118 Marso S. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. New England Journal of Medicine. 2016;375(4):311-322. doi:10.1056/ NEJMoa1603827 Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine. 2021;384(11):989-1002. doi:10.1056/ nejmoa2032183 Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. 2022;387(3):205216. doi:10.1056/nejmoa2206038 A LM. Semaglutide and Cardiovascular Outcomes in Obesity without

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Diabetes. New England Journal of Medicine. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563

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Assessing opioid overdose awareness: A mixed-methods study evaluating the impact of an educational presentation on a college campus By: Dr. Susan Smith and Dr. Rama Shamieh Abstract Objective: The primary purpose of this study was to determine whether a presentation on signs and symptoms of opioid overdose and naloxone use increased attendee knowledge and confidence preand post-intervention. Methods: A mixed-methods approach was utilized to gauge college students’ understanding of opioid overdoses and naloxone use. A presentation on opioid overdose and its treatment was delivered to adult undergraduate and graduate students, faculty, staff, and guests of a private university. Pre- and post-presentation surveys assessed attendees’ baseline knowledge of opioid overdose signs and symptoms as well as gauged understanding regarding the use of naloxone in overdose situations. Survey questions included multiple-choice and open-ended questions. Participants were asked to rate their confidence in recognizing signs and symptoms of an opioid overdose (scale 1 to 10, 10 = very confident).

Results: Fifty-three attendees (n=11 [21%] graduate students, n=42 [79%] undergraduate students) completed both surveys. The mean pre- and post-presentation confidence of attendees in recognizing overdose signs and symptoms was 4.5 and 7.9, respectively (p<0.001). Prior to the presentation, 9% (n=5) of participants correctly identified signs and symptoms of an overdose; this improved to 34% (n=18) post-presentation. When asked if a prescription was needed for naloxone, most participants stated they were unsure (n=22, 42%). After the presentation, 92% (n=49) of participants stated a prescription was not needed. In response to the open-ended question “What is naloxone used for?” 57% (n=30) correctly stated “opioid overdose reversal”; this improved to 85% (n=45) post-presentation. Conclusion: A presentation on opioid overdose and naloxone use can significantly improve attendee knowledge as well as improve self-perceived confidence in recognizing overdose situations. Educational efforts geared specifically toward undergraduate students can Page 17

be impactful. Introduction The opioid crisis has caused a substantial increase in deaths in North America, particularly among young adults. In 2022, opioids caused the deaths of 79,770 people in the United States (US) (1). Although there has been a decline in the number of opioid prescriptions in the past decade, the number of opioid-related deaths is still on the rise (2). Prescription opioid misuse remains an important public health concern among young a d u l t s . Recent Centers for Disease Control reporting shows that overdose deaths among adolescents and other youth have increasingly involved illicitly manufactured fentanyl, and counterfeit pills are a documented part of that risk environment (3,4). These findings support continued efforts to educate college students and other young adults about recognizing counterfeit tablets and understanding the dangers of nonmedical pill use.

Naloxone is a life-saving drug that reverses an opioid overdose and rapidly reverses the effects of opioid overdoses. A scoping review revealed that knowledge gaps exist for both patients and healthcare professionals related to naloxone use (5). The most common knowledge gaps in this review were lack of awareness and misinformation among patients and/or the public (5). For example, most patients believed only individuals using illicit substances needed naloxone or that patients taking chronic opioids were not at risk of an opioid overdose (5). It would appear that education related to naloxone use is an important strategy to prevent opioid overdose deaths (6). By providing naloxone education and training, young adults are empowered to act swiftly and effectively during emergency situations (6,7). Access to naloxone and the knowledge to administer it can mean the difference between life and death for someone experiencing an opioid overdose (8). Moreover, educating individuals on the use of naloxone, especially on college campuses, promotes a sense of responsibility and solidarity, which encourages taking proactive measures in combating the opioid crisis (9,10). A recent study examined college students’ knowledge of opioid overdose and found that students who previously attended a naloxone educational presentation or training in the past scored higher on an overdose knowledge scale than those who had not (9). As noted, the opioid crisis has extended its reach to college campuses, where prescription opioids are notably the most commonly used form among students (10). Within the college student population, there was a 343% increase in opioid

use from 1993 to 2005, with 50% of students reporting that they had been offered prescription opioids for nonmedical use by their second year in college (11). Data from the Substance Abuse and Mental Health Services Administration indicates that college-age adults have significantly higher rates of prescription opioid misuse than adolescents and adults 26 years and older (12). The college student population is of particular interest not only due to this heightened risk in young adults, but also because it may provide valuable insights into the effectiveness of education-based interventions.

All students received Lyceum credit for attending the event. Pharmacy students attending the event also received Center for the Advancement of Pharmacy Education domain credit for the professional, self-aware, or advocate domain as part of the school of pharmacy’s co-curriculum (13). Lyceums are advertised to and open to all members of the campus community, including faculty, staff, and members of the community (“guests”).

The 50-minute educational session covered a range of topics, including an overview of opioids and their physiological impact, recognition The primary objective of this study of the signs and symptoms assowas to evaluate whether a presen- ciated with opioid overdose, and tation on opioid overdose signs and appropriate response strategies symptoms increased awareness of to an opioid overdose. Additionand confidence in recognizing signs ally, a patient case involving an inand symptoms of opioid overdose dividual who had experienced an before and after an educational in- opioid overdose was introduced at tervention. In addition to the pri- the outset of the presentation and mary objective, the research proj- subsequently discussed toward the ect aimed to assess awareness of conclusion of the event. Audience intranasal naloxone and its situa- members were asked to complete tional use at a private university. and submit a survey (Google Form) before and after the presentation. Methods The study population comprised individuals attending the Lyceum lecEducational intervention ture, including undergraduate and An educational presentation relat- graduate students, faculty, staff, ed to opioid overdose and treat- and guests. Excluded from particment was held on campus at a pri- ipation were individuals under 18 vate institution of higher education years of age and those who comas part of an academic lecture Lyce- pleted only a single survey, either um event. Co-presenters included the pre-survey or the post-survey a pharmacy faculty member and exclusively. a pharmacy student. Lyceums are educational opportunities offered Survey Development in four areas: academic lectures, faith, growth, and arts. As a gradu- Pre- and post-presentation suration requirement, undergraduate veys assessed attendees’ baseline and graduate students are required knowledge of the signs and sympto attend a certain number of Lyce- toms of opioid overdose as well as ums each year. Students self-select gauged understanding regarding the Lyceums they wish to attend. the use of naloxone in overdose Page 18

situations. The surveys included demographic questions as well as multiple-choice and open-ended questions. Demographic questions included participant type (student, faculty, staff, or guest), education level (undergraduate, graduate), and current major. Additionally, students were asked to rate their confidence in recognizing signs and

symptoms of an opioid overdose using a Likert scale from 1 to 10, where 1 was not confident at all, and 10 was very confident. (Figure 1) Participation in the study was indicated by submitting the survey, which also served as the informed consent. Participants younger than 18 years of age were excluded from

the study. Participants who completed only one survey were also excluded. Data Analysis In the statistical analysis of the survey results, a combination of quantitative and qualitative approaches was employed. Quantitatively,

Figure 1. Survey pre- and post-presentation.

On a scale of 1-10, how confident are you in recognizing the signs and symptoms of an opioid overdose? (1 = not confident at all, 10 = very confident). Circle the number that best describes your level of confidence. Not confident at all 1 2 3 4 5 6 7 8 9 10 Very confident Which of the following are signs and symptoms of an opioid OVERDOSE? (SELECT ALL THAT APPLY) • unresponsive • shallow breathing • dilated pupils • infected toenail • nausea or vomiting • chest pain • loss of coordination • low blood sugar

What is the first course of action you should take after noticing that someone may be experiencing an opioid overdose? What is naloxone (Narcan) used for? Where can naloxone (Narcan) be obtained? Do you need a prescription to obtain naloxone (Narcan)? (Select 1 response) • Yes • No • I don’t know What forms does naloxone (Narcan) come in? (SELECT ALL THAT APPLY) • tablet • nasal spray • injection • patch What will happen to someone after naloxone (Narcan) is given? Who would benefit MOST from carrying naloxone (Narcan)? (SELECT ALL THAT APPLY) • Someone who has experienced a prior opioid overdose • Someone who has a history of alcohol or substance use disorder • Someone who has kidney or liver impairment • Someone who is taking high opioid doses • Someone who is taking other sedating medications/substances Have you ever heard of the Good Samaritan law? • Yes • No • I don’t know Page 19

the analysis focused on measuring changes in knowledge and attitudes before and after an educational intervention using descriptive statistics. For instance, the change in the percentage of participants correctly identifying signs and symptoms of an opioid overdose, and the improvement in recognizing the availability of naloxone were quantified using frequencies and Table 1. Participant majors and education

Major n (%)

Highest level of education n (%)

tion; alternatively, fewer students The study methods were approved incorrectly selected dilated pupils by the institution’s Research Re- as an opioid overdose sign post-inview Board. tervention. Additionally, post-education, students recognized that Results hypoglycemia is not associated with an opioid overdose; however, Fifty-three participants (n=11 [21%] more students selected “infected graduate students, n=42 [79%] un- toenail” as a symptom compared dergraduate students) completed to pre-intervention. The mean preboth surveys (Table 1). Non-student and post-presentation confidence of attendees in recognizing overdose signs and symptoms was 4.5 and 7.9, respectively (p<0.001). Undergraduate n = 42

Graduate n = 11

Business

4 (9.5%)

0 (0%)

Education

5 (11.9%)

0 (0%)

STEM (biology, exercise science, pre-professional health science, nursing, pharmacy, psychology)

23 (54.8%)

9 (81.8%)

Other (community and commercial recreation, criminal justice, human services, religious studies, sports management/media)

8 (19.0%)

1 (9.1%)

Did not answer

2 (4.8%)

1 (9.1%)

High school diploma

16 (38.1%)

1 (9.1%)

Some college

24 (57.1%)

4 (36.4%)

Associate degree

2 (4.8%)

1 (9.1%)

Bachelors

0 (0%)

5 (45.5%)

percentages. Inferential statistics (t-test) were used to assess the significance of these changes, as indicated by p-values (e.g., the change in confidence levels). These statistical measures provided a numerical representation of the educational intervention’s impact on participants’ knowledge and confidence. The qualitative analysis component of the study examined participants’ responses to open-ended questions, including indications for naloxone, actions to take when encountering a non-responsive person, and patients’ responses after naloxone administration.

participants did not complete the surveys. Prior to the educational intervention, 9% (n=5) of participants correctly identified all the signs and symptoms of an opioid overdose and did not select an incorrect response. Although this improved to 34% (n=18) post-intervention, this increase was not statistically significant (p=0.23). (Figure 2). Students improved in their recognition of shallow breathing, unresponsiveness, nausea, vomiting, and chest pain as signs of an opioid overdose. Fewer students correctly selected loss of coordination as a sign of an opioid overdose after the intervenPage 20

Regarding knowledge of naloxone, when asked whether a prescription was needed for naloxone, most participants stated they were unsure (n=21, 40%). After the presentation, 92% (n=49) of participants stated a prescription was not needed (p<0.001). Prior to the educational intervention, 28% (n=15) of participants correctly stated that naloxone is available as both an intranasal spray and an injection. This percentage improved to 74% (n=39) post-intervention (p<0.001). Attendees were asked if they had ever heard of the Good Samaritan Law. Prior to the presentation, 39 (73.6%) selected “yes”, 12 (22.6%) selected “no”, and 2 (3.8%) responded, “I don’t know.” After the presentation, all but one respondent stated that “yes,” they had heard of the Good Samaritan Law (n=52, 98%). Attendees were asked several open-ended questions. In response to the open-ended question “What is the first course of action you should take after noticing that someone may be experiencing an opioid overdose?”, prior to the presentation, 31 (58.5%) participants stated, “call 911” or “call for help.”

Figure 2. Signs and symptoms of opioid overdose, percent correct pre- and post-intervention.

Signs and Symptoms of Opioid Overdose Percent Correct Pre and Post Intervention

loss of coordination chest pain

nausea vomiting

shallow breathing

unresponsive

0%

Six (11.3%) responded with “check breathing” or “check responsiveness,” five (9.4%) said they “would give Narcan,” and four (7.5%) said they did not know what to do. Of the remaining seven participants, responses were as follows: “give CPR,” “find cause,” “keep awake,” “get to hospital,” (n=2), and “position person” (n=2). The number of participants who would “call 911” or “call for help” increased to 49 (92.5%) after the presentation. The remaining four respondents stated they would “call the hospital,” “check pupils,” and “give Narcan.” (n=2) In response to the question “What is naloxone used for?” 57% (n=30) stated “opioid overdose reversal”; this improved to 85% (n=45) post presentation (p=0.06). Of the 23 attendees prior to the presentation who did not describe naloxone as an opioid overdose reversal agent, 15 (28.3%) did not know what naloxone is used for, and the remaining eight participants stated naloxone is used to “treat pain,” “for sickness,” “opens up the airway,” “flushes the drug out,” “does something about

10%

20%

30%

% correct pre

40%

50%

60%

% correct post

70%

the symptoms,” “gets the person off narcotic addiction,” “provides shock needed after an overdose,” and “prevents opioid overdose.” After the presentation, three participants stated naloxone is used for “pain,” two stated it is used “to prevent an opioid overdose,” and one respondent each stated “having control with opioid use,” to deter the opioid from messing with the brain,” and “to wake them up.” Prior to the presentation, 16 (30.2%) respondents did not know where to obtain naloxone, while 22 (41.5%) respondents noted naloxone can be obtained from a pharmacy. Several respondents (n=10 [18.9%]) stated that naloxone can be obtained from a doctor, a hospital, or first responders. The remaining four respondents stated “drug dealers,” “over the counter,” “pills,, “store.” One respondent did not answer the question. After the presentation, the number of respondents who stated naloxone can be obtained from a pharmacy rose from 22 (41.5%) to 46 (86.8%) (p<0.001), with the remaining seven respondents stating “nasal Page 21

80%

90% 100%

spray” “provider” (n=2), “plants” (n=2), and “hospital” (n=2) Students were asked to describe “What will happen to someone after naloxone (Narcan) is given?” Prior to the presentation, most responses (n=21, [38.1%]) described that a person would regain consciousness, become responsive, wake up, breathe again, and/or experience reversal of the opioid overdose. Twelve responses (21.8%) described a scenario in which the person would undergo withdrawal and/or be agitated, aggressive, combative, or unhappy. One respondent stated the naloxone would rejuvenate the person, while another stated naloxone would sedate the person. Twenty (36.4%) did not know what would happen after the person received naloxone. After the presentation, 45 (84.9%) described that a person would regain consciousness, become responsive, wake up, breathe again, and/or experience reversal of the opioid overdose. Five respondents (9.4%) described a scenario in which the person would undergo withdrawal and/or be agitated or

angry. One respondent each stated naloxone would allow the brain to work correctly again, relieve pain, and that more would need to be given if unresponsive. No participants provided “I do not know” as a response. Discussion It is unlikely that anyone disputes the fact that the negative effects of opioid misuse in the US today are consequential. The causes are multifactorial and require active involvement by members of the healthcare team and the public at large to reverse this negative trajectory. Prescribers should use caution to prescribe opioids appropriately to patients who need them in quantities that are necessary to treat acute pain. Campaigns to increase public awareness of the dangers of opioid overdose, as well as how to obtain and use life-saving naloxone therapy, are important public health priorities. This study aimed to increase public awareness of opioid overdose and its treatment in a vulnerable population: college students and the campus community at large. We evaluated student perceptions by pre- and post-presentation surveys. To our knowledge, this is the first analysis utilizing a mixed-methods approach to evaluate student confidence before and after receiving education on opioid use, signs and symptoms of opioid overdose, naloxone therapy, and managing a person experiencing the effects of an opioid overdose. Our findings showed students self-reported an increase in their confidence in being able to recognize signs and symptoms of overdose after participating in this educational event. Ad-

ditionally, students increased their what to do about it: knowledge of where to obtain naloxone and that a prescription is not “That I can identify a person overneeded. Students were prompted dosing and know what to do.” to share their main take-away from the presentation as the last ques- “Constricted/pinpoint pupils are tion in the post-presentation sur- indicative of an opioid overdose.” vey. Many participants commented on the role of naloxone: “That treating [someone] with an overdose can be [done] by every“Opioid overdose is real, and there day people.” are many resources like medications such as Narcan that can [be] “How everyone can benefit the beneficial in this situation. “ public from being able to identify and treat an OD.” “My biggest takeaway was learning step by step on how to utilize “This allowed me to have a better Narcan.” understanding of what to look for in someone who is having an “I learned that I can carry Narcan overdose and how to help them if just in case I find someone who they are” needs it.” In our study, only nine (17%) partic“I am much more confident that I ipants correctly recognized all five could calmly and confidently save of the given scenarios in which a someone’s life if I had naloxone, person would benefit from carrying or I could get them the help they naloxone prior to the presentation. needed in case of an opioid over- This number increased to 35 (66%) dose.” post-presentation (Figure 3). Most of the participants in our study recOther participants commented on ognized the benefit of patients on having more confidence in recog- high opioid doses carrying naloxone nizing the signs and symptoms of pre- (n=45 [85%] and post- (n=51 an opioid overdose and knowing [96%]) presentation. Figure 3. Student identification of persons benefiting most from carrying naloxone pre- and post-presentation.

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Most participants in this study had heard of the Good Samaritan Law prior to the presentation. While specific details of the Good Samaritan Law may vary from state to state, all 50 states in the US have enacted some form of this law. Essentially, this law protects individuals from liability when they voluntarily assist others who may have been injured or are in distress. The purpose of this law is to encourage bystanders to help another person in need without fear of repercussions for unintentional harm. This protection also extends to providing immunity for a bystander who sought assistance from 911, emergency medical services, or law enforcement to help a person experiencing a drug-related overdose. Even if bystanders were involved in illegal activity as it relates to possession or use of small amounts of illegal substances, they are encouraged to call 911 to save another person’s life; a call that may not happen if the bystanders are worried about getting in legal trouble for possession of drugs. In North Carolina, the Good Samaritan Law includes protection for drug-related overdoses. As our survey question focused on whether participants had merely heard of this law, it is unknown whether they were aware of the additional bystander immunity clause.

post-presentation survey to leave the event. Our university is a small, private university situated in a rural area of the county. The unique characteristics of this setting may not accurately reflect the diverse experiences and educational environments found in larger or more urban university contexts, thereby limiting the generalizability of our findings. Participants were students in both undergraduate and health science graduate programs, which may have created bias among our student groups. The presence of healthcare students in the audience, along with potential biases stemming from participant interest in the topic, might have skewed the results, suggesting that the enthusiasm or prior knowledge of these participants could have influenced the outcomes compared to a more varied group. Another significant limitation is the absence of longterm follow-up. Our study does not evaluate knowledge retention over time or the long-term impact of the educational intervention, leaving unanswered questions about the enduring effects of the provided content. Lastly, some unexpected responses in the post-intervention survey, such as the incorrect identification of an “infected toenail” or the failure to recognize pupil constriction as a symptom of opioid overdose, may indicate possible misunderstandings or a lack of attention during the presentation or survey completion. These responses suggest that some aspects of the intervention may not have been effectively communicated or that participants may not have been fully engaged, raising concerns about the clarity and delivery of the educational material.

Our study has some limitations that should be considered when interpreting the findings. This single-university analysis evaluated students, faculty, and guests electing to participate in an evening presentation. Presenters provided participants with time at the beginning and the end of the presentation to complete the survey, but attendees may have rushed through the Our study has multiple strengths Page 23

that enhance its contribution to the literature. A notable strength lies in our focus on college undergraduate students, a group identified as particularly at risk for opioid overdose. By targeting this demographic, our research provides valuable insights into the potential effectiveness of educational interventions designed to increase awareness and knowledge about opioid overdose and naloxone use. A unique strength of our study is the utilization of a mixed-methods approach, combining both qualitative and quantitative research methods. Qualitatively, the analysis examined the content of open-ended responses to explore participants’ understanding and perceptions. Before the intervention, a range of responses to what actions to take in case of an opioid overdose highlighted a diverse level of awareness and preparedness among the participants. This qualitative analysis complements the quantitative data by providing context and depth, revealing not just the extent of the knowledge shift but also the nature of this shift. Similarly, responses to what naloxone is used for and the expected outcomes after its administration were analyzed to understand misconceptions and the effectiveness of the intervention in correcting them. The qualitative aspect of the analysis was crucial in interpreting how and why changes in knowledge and attitudes occurred, thereby providing a comprehensive understanding of the intervention’s impact. This strategy allowed for a deeper dive into the nuances of how educational efforts impact student perceptions and knowledge. Additionally, our study highlighted the broader effects of graduate

and undergraduate interaction in enhancing learning and awareness across the campus. The involvement of a graduate program in the educational initiative not only fostered greater interprofessional engagement across different levels of study but also showcased the role healthcare and pharmacy students at various stages of their education can play in community health initiatives.

Our study was performed to assess opioid overdose awareness among college students through educational presentations. The study highlighted both the need for and effectiveness of such initiatives. The research outcomes demonstrated a significant increase in students’ knowledge and confidence in recognizing and responding to opioid overdoses. Our efforts represent a proactive approach to public health education, aligning with broader A final strength of our study is the strategies to mitigate the impact of potential real-world impact of our the opioid epidemic. By equipping educational efforts. While direct college students and other cameffects on life-saving actions are pus community members with the difficult to quantify, the possibility knowledge and skills to act in emerthat this initiative could prevent an gency situations involving opioid overdose death adds a significant overdoses, we hope to contribute motivational and ethical dimension to a safer, more informed commuto our work. This potential impact nity capable of preventing potenunderscores the importance of con- tially fatal outcomes. tinuing to develop and implement educational interventions aimed at Authors: (Corresponding) Sureducing the risk of opioid overdos- san Smith, BS, PharmD, BCPS, es among at-risk populations. To su.smith@wingate.edu, is an Asextend the reach and impact of this sociate Professor of Pharmacy and knowledge, our institution actively Director of Interprofessional Educaensures that all pharmacy students tion at Wingate University in Winhave access to this crucial training gate, NC. Rama Shamieh, PharmD, through initiatives such as Save A is a Clinical Science Postdoctoral Life by the Alliance of Coalitions for Fellow at Takeda. Healthy Communities (14). This effort is spearheaded by professional References student organizations on campus, demonstrating a proactive commitment to increasing both access 1. Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose and awareness among our student death counts. National Center for body. Through these concerted efHealth Statistics. 2024. Accessed May 12, 2026. https://www.cdc.gov/nchs/ forts, our institution is not only connvss/vsrr/drug-overdose-data.htm tributing to a broader public health 2. Kharasch ED, Clark JD, Adams JM. Opiresponse to the opioid epidemic oids and public health: The prescripbut is also taking tangible steps to tion opioid ecosystem and need for empower our students with the improved management. Anesthesiology 2022;136(1):10-30. DOI: 10.1097/ knowledge and resources needed ALN.0000000000004065 to save lives. Conclusions

3. Tanz LJ, Dinwiddie AT, Mattson CL, et al. Drug overdose deaths among persons aged 10-19 years – United States, July 2019-December 2021. MMWR Morb Page 24

Mortal Wkly Rep 2022;71(50):15761582. doi.org/10.15585/mmwr. mm7150a2 4. O’Donnell J, Tanz LJ, Miller KD, et al. Drug overdose deaths with evidence of counterfeit pill use – United States, July 2019-December 2021. MMWR Morb Mortal Wkly Rep 2023;72(35):949-956. doi. org/10.15585/mmwr.mm7235a3 5. Cid A, Daskalakis, Grindrod K, Beazely. What is known about community pharmacy-based take-home naloxone programs and program interventions? A scoping review. Pharmacy 2021;9(30):1-32. doi.org/10.3390/ pharmacy9010030. 6. Mayet S, Manning V, Williams A, et al. Impact of training for healthcare professionals on how to manage an opioid overdose with naloxone: Effective, but dissemination is challenging. Int J Drug Policy. 2011;22(1):9-15. doi. org/10.1016/j.drugpo.2010.09.008. 7. Behar E, Santos GM, Wheeler E, et al. Brief overdose education is sufficient for naloxone distribution to opioid users. Drug Alcohol Depend. 2015;148:209-212. doi.org/10.1016/j. drugalcdep.2014.12.009 8. Kosobuski L, O’Donnell C, Koh-Knox Sharp CP, et al. The role of the pharmacist in combating the opioid crisis: An update. Subst Abuse Rehabil. 2022;13:127-138. doi.org/10.2147/ sar.s351096 9. Vyas R, Bailey K, Vyas N, Compton P. College students’ knowledge about opioids and implications for the opioid crisis. J Am Coll Health. 2023;71(1):147-153. doi.org/10.1080 /07448481.2021.1881102 10. Stover AN, Grogg K, Patel J, et al. Opioid overdose knowledge among college students in a high overdose death state. J Hum Behav Soc Environ. 2019;29(7):887-896. doi.org/10.1080 /10911359.2019.1633981 11. Daniels-Witt Q, Thompson A, Glassman T, et al. The case for implementing the levels of prevention model: Opiate abuse on American college campuses. J Am Coll Health. 2017;65(7):518-524. doi.org/10.1080/07448481.2017.134 1900 12. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on

Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ Accessed May 12, 2026. 13. Medina MS, Plaza CM, Stowe CD, et al. Center for the Advancement of Pharmacy Education 2013 educational outcomes. Am J Pharm Educ. 2013;77(8):162. doi.org/10.5688/ ajpe778162 14. Alliance of Coalitions for Healthy Communities. (2023). NARCAN training – Save a life. Alliance of Coalitions for Healthy Communities. Retrieved from: https://achcmi.org/programs/ harm-reduction/narcan-training-savea-life (Accessed May 16, 2026)

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Impact of Service Area Community Pharmacy Licensure Changes on Prescription Volume at a Full-Service Independent Community Pharmacy Operation

By: Dr. Caroline Montgomery, Dr. Dustin Wilson, and Dr. Katie Trotta Abstract

ber 31, 2025. Records with missing ZIP code information, incomplete Background: Community pharma- dispensing data, or missing vaccies play a vital role in healthcare cine geographic data were excludaccess. Pharmacy closures, partic- ed. Pharmacy licensure data were ularly among independent phar- obtained from the North Carolina macies, reduce access to care and Board of Pharmacy to identify pharincrease demand for remaining macy openings and closures. Depharmacies. This study examined scriptive analyses were performed. how changes in surrounding pharmacies impacted service utilization Results: From 2019 to 2025, the at Healthwise Pharmacy, an inde- surrounding service area experipendent full-service pharmacy in enced a net loss of seven commuGreenville, North Carolina. nity pharmacies, with 14 openings and 21 closures across Pitt County Objectives: This study aimed to de- and six surrounding counties. Retail scribe changes in retail prescription prescription volume increased from volume at Healthwise Pharmacy in 34,445 in 2019 to 50,284 in 2024 relation to changes in communi- and remained elevated at 47,664 ty pharmacy licensure within Pitt in 2025. Compounded prescripCounty and six surrounding coun- tions increased from 438 in 2021 to ties from 2019–2025. Secondary 5,432 in 2025. Adherence packagobjectives included describing ing increased from 1,768 in 2019 to changes in compounded prescrip- 11,227 in 2025. Vaccine administrations, vaccine administration, and tion peaked at 1,058 doses in 2022, adherence packaging utilization. then declined to 595 in 2025.

fect workload, patient access, and service delivery, and may inform strategies to strengthen pharmacy sustainability, preserve healthcare access, and mitigate the growth of pharmacy deserts. Background

Community pharmacies play a vital role in providing accessible health care for many individuals. Whether dispensing medications, providing patient counseling, administering vaccinations, supporting medication therapy management services, or offering adherence-support programs such as bubble-pack prescriptions, these services can improve patient outcomes and help reduce overall health care costs. As a result, many individuals seek care from community pharmacies (1). Recent data show that nearly one in three retail pharmacies in the United States have closed since Methods: This IRB-approved, ret- Conclusions: Independent commu- 2010, contributing to a substantial rospective, observational study nity pharmacies remain essential to decline in pharmacy availability utilized Healthwise Pharmacy’s Pio- patient care and medication access. (2). More specifically, independent neerRx system to collect data from These findings provide insight into pharmacies are more than twice as January 1, 2019, through Decem- how pharmacy closures may af- likely to close as chain pharmacies (2). Communities lacking a nearby Page 27

pharmacy create what is known as a pharmacy desert, where individuals must travel more than one mile in urban areas or more than 10 miles in rural areas to reach the nearest pharmacy (3). Because of these pharmacy deserts, approximately one in seven Americans lack convenient access to a pharmacy, and over 48.4 million people in the United States live in areas where filling a prescription requires a significantly longer drive (4). In addition, the remaining pharmacies in the area experience increased prescription volume and expanded delivery demands, placing additional strain on pharmacy staff (5). Healthwise Pharmacy, located in Greenville, North Carolina, operates as a full-service, independent community pharmacy serving a diverse patient population across multiple counties in eastern North Carolina. In addition to traditional dispensing, Healthwise Pharmacy offers expanded clinical, specialty, and support services, including compounding, vaccinations, adherence packaging, infusion management, and nutrition support. In recent years, the pharmacy team has observed what appears to be a steady increase in prescription volume, with patients traveling farther and delivery drivers traveling farther to cover a wider service area (6). While population growth and demographic shifts in the area may influence these observations, the impact of changes in community pharmacy licensure has not been investigated. Therefore, the purpose of this study was to examine how changes in the number of surrounding pharmacies affected service utilization at Healthwise Pharmacy. Methods

The primary objective of this IRB-approved, retrospective observational study was to describe changes in retail prescription volume at Healthwise Pharmacy in relation to community pharmacy licensure changes within Pitt County and six surrounding counties from 2019 to 2025. Secondary objectives included evaluating changes in compounded prescription volume, vaccine administration, and adherence packaging utilization over the same study period. Community pharmacy licensure data were obtained from the North Carolina Board of Pharmacy (NCBOP) to identify pharmacy openings and closures within Pitt County and six surrounding counties (Beaufort, Greene, Lenoir, Martin, Edgecombe, and Wilson) between January 1, 2019, and December 31, 2025. Pharmacy service utilization data were extracted from the PioneerRx dispensing system and included retail prescription volume, compounded prescription volume, vaccine administration, and adherence packaging utilization. Of note, compounding data were available from January 1, 2021, through December 31, 2025, due to a pharmacy system transition. Retail prescription analyses excluded total parenteral nutrition and infusion services. Records with missing ZIP code information, incomplete dispensing data, or vaccine encounters lacking geographic identifiers were excluded from the analysis. Descriptive statistics were used for all analyses. Absolute numbers were calculated to summarize annual trends in community pharmacy licensure changes and pharmacy service utilization, while percent change over the 5-year study period was used to evaluate changes in Page 28

service utilization across years. Results From 2019 to 2025, the surrounding service area experienced a net loss of seven community pharmacies, with 14 openings and 21 closures across Pitt County and six surrounding counties. All pharmacy services increased over the study period. The total retail prescription volume was 310,025 prescriptions, representing an overall increase of 38.1% (Figure 1). Compounded prescription volume increased from 438 prescriptions in 2021 to 5,432 prescriptions in 2025, representing a 1,140% increase (Figure 2). Adherence packaging utilization increased from 1,768 prescriptions in 2019 to 11,227 prescriptions in 2025, representing a 534% increase (Figure 3). Lastly, vaccine administration increased from 33 prescriptions in 2019 to 595 prescriptions in 2025, representing a 1,703% increase (Figure 4). Discussion In this study, retail prescription volume, compounding services, adherence packaging utilization, and vaccine administration increased during a period characterized by a net loss of seven community pharmacies in the surrounding service area. Similar patterns of pharmacy closures have been described in the literature, with a decrease in independent pharmacy locations and worsening access to pharmacy services, especially in rural and underserved communities (2,3). These closures are linked to increased workload on the pharmacies that remain as they take on more prescription volume. Retail prescription volume at Healthwise Pharmacy increased substantially over the study period,

suggesting increased workload and demand on the remaining community pharmacies. Although prescription volume plateaued slightly in 2025 despite two pharmacy closures, utilization remained above baseline levels. This finding may reflect operational shifts within the community pharmacy landscape, including increased utilization of closed-door services and external

factors such as mail-order pharmacies, which may have offset the expected increase in prescription demand in 2025. Compounding prescription volume demonstrated steady growth throughout the study period. However, these findings may underestimate the true workload associated with compounding services because prescriptions lacking ZIP Page 29

code information were excluded from the analysis. Adherence packaging utilization also increased significantly over the study period. This growth may be attributable to Healthwise Pharmacy being one of the few independent pharmacies in Pitt County that offer adherence packaging services, as well as targeted expansion efforts following the implementation of the community-based pharmacy residency program in 2023. The increased utilization of adherence packaging services may also reflect a growing need for medication adherence support among patients managing complex medication regimens. Vaccine administration peaked in 2022 before declining in subsequent years. This trend aligns with expanded pharmacy-based immunization efforts and increased demand for preventive healthcare services following the COVID-19 pandemic (7). While retail prescription volume increased throughout the study period, non-traditional dispensing services grew much more. This can indicate a growing trend towards an increased focus on non-dispensing services often seen in community pharmacies, specifically independent pharmacies, in today’s pharmacy landscape. The growth of these clinical services highlights the indispensable role of pharmacists in community settings. A strength of this study was the evaluation of longitudinal trends over five years using real-world dispensing and service utilization data from an independent community pharmacy. Additionally, integration of regional pharmacy licensure data provided important context regarding changes in local pharmacy access. Several limitations should be considered. First,

this was a single-site study, which may limit generalizability to other community pharmacy settings, particularly larger chain pharmacies. Second, compounding data were only available beginning in 2021 due to a pharmacy system transition. Finally, multiple potential confounders were not controlled for, including workflow changes, delivery route expansion, seasonal variation, COVID-19-related effects, and other operational factors that may have influenced service utilization. Conclusion Independent community pharmacies may experience increased prescription demand and service utilization as regional pharmacy closures continue. These findings highlight the critical role independent community pharmacies play in maintaining medication access and expanding clinical services, especially within rural and underserved communities. These results also demonstrate that clinical pharmacy services such as immunizations, adherence packaging, and compounding can grow alongside traditional dispensing, highlighting the expanding role of community pharmacies beyond conventional medication distribution. As the role of community pharmacy continues to evolve, future opportunities may include expanded engagement in point-of-care testing services and participation in collaborative practice networks, such as the Community Pharmacy Enhanced Services Network, to further support patient care delivery. Future research should evaluate the long-term sustainability of these services and their impact on patient outcomes as the community pharmacy land-

scape continues to evolve. Acknowledgements

4.

The authors would like to acknowledge Richard Drew, PharmD, MS, FCCP, FIDP, and Paige Lloyd, 5. PharmD, MSCR, for their contributions to the study. Authors: (Corresponding author) 6. Caroline Montgomery, PharmD, at the time of this submission, was a PGY-1 Community-Based Pharmacy Resident with Campbell University College of Pharmacy & Health Sciences and Healthwise Pharmacy; crmontgomery0129@email. campbell.edu. She is currently a Staff Pharmacist at Realo Extended Care Pharmacy. Dustin Wilson, PharmD, BCPS, FNCAP, is an Associate Professor of Pharmacy Practice at Campbell University College of Pharmacy & Health Sciences and Duke University Health System. Katie Trotta, PharmD, BCACP, is a Clinical Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy & Health Sciences. References 1.

2.

3.

Berenbrok LA, Tang S, Gabriel N, et al. Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. J Am Pharm Assoc (2003). 2022;62(6):1816-1822.e2. doi:10.1016/j.japh.2022.07.003. Qato DM, Guadamuz J, Kanter G, Alexander GC; USC Leonard D. Schaeffer Center for Health Policy & Economics. Nearly 1 in 3 retail pharmacies have closed since 2010, widening health disparities. Health Aff (Millwood). Published December 3, 2024. Accessed July 16, 2025. Qato DM, Daviglus ML, Wilder J, Lee T, Qato D, Lambert B. “Pharmacy deserts” are prevalent in Chicago’s predominantly minority communities, raising medication access Page 30

concerns. Health Aff (Millwood). 2014;33(11):1958-1965. doi:10.1377/ hlthaff.2013.1397. Marsh T, Cisneros T. 48.4 Million Americans lack adequate access to a pharmacy. GoodRx. Updated March 20, 2025. Accessed July 11, 2025. Murphy M, Herbert S. Community pharmacies are closing. Here’s what to do if your neighborhood location does too. PBS NewsHour. Published February 22, 2025. Accessed July 16, 2025. Healthwise Pharmacy. https://www. healthwisepharmacy.com. Accessed July 29, 2025.Meador SA, Lamias MJ, Kroger A, Santibanez TA, Lu PJ, Singleton JA. Trends in pediatric and adult COVID-19, influenza, and routine vaccinations administered in retail pharmacies, 2015 through 2023, United States. Am J Infect Control. Published online April 17, 2026. doi:10.1016/j. ajic.2026.04.011

Member Spotlight Ashley Leggett, PharmD

Background and Career Journey What inspired you to become a pharmacist? I knew as a high school student that I wanted to pursue a career in healthcare but just could not decide. I was at the local stampede in town on a random Saturday and had a quick conversation with the director of the high school apprenticeship program at the time, who said the local pharmacy was looking for a high school apprentice. It was through this apprenticeship opportunity that I became motivated to become a pharmacist.

tes Education certification, Veterinary Compounding certificate, Hormonal Contraception Prescribing, and Long-Acting Injectables. Most recently, I became licensed as a Medicare insurance agent because many do not understand the basics behind Medicare and their coverage. My next goal is achieving a board certification in ambulatory care.

Could you walk me through your path from pharmaWhat are the key moments, mentors, or advice that cy school to becoming a pharmacy owner? When and have shaped your career thus far? where did you graduate? What additional training have you pursued? Most of my key moments and mentors that have shaped my career have been from Mutual Drug memI graduated from UNC Eshelman School of Pharmacy bers. My first pharmacy job and pharmacy colleagues in May 2012 with a job lined up at the same pharmacy (Chad Duke, Eleyse Griffin, Gigi Taylor) shaped me into that shaped my career path. I worked there for sevunderstanding and providing top-notch customer sereral years building clinical services and compounding. vice and advancing my understanding of insurance When I took over as manager in 2017, the desire to rejections and solutions. Thomas and Joe McDowell own grew stronger as I wanted to advance the pharwere great in transforming my thought process from macy profession, and while I met resistance, I knew a “reactive “ to a “ proactive” approach to keep paownership would give me decisive power. tients engaged and become the healthcare hub in the community. Jennifer Burch and dad, Bill, allowed me I have acquired various certificates over the years, to learn so much about compounding techniques, horincluding advanced compounding certificates, DiabePage 31

mone replacement, and other “niche” products that Could you describe some of your advocacy efforts withare not traditionally known. Every experience I have in NC pharmacy? had has shaped the pharmacist that I am now and continue to be. This area needs my attention. I have not been involved in advocacy in the past, as the day-to-day activities are Business Ownership not something I understand easily. Government things really do not interest me, but I am starting to learn What motivated you to open your own pharmacy? that the more our voices are heard, the more we can educate our legislative leaders to drive positive deciHonestly, there were several services and advanced sion-making. At a minimum, we need to have convertrainings that I wanted to pursue. When I was met sations with local AND state-level government officials with resistance and hesitation from other owners, I to help keep us rooted in our communities so they knew that my desire to have the services available to know our value and worth! my community was going to come with store ownership. Why is it important for pharmacists to be involved in advocacy? What have been the greatest challenges in opening and running a pharmacy? We must push forward for PBM reform and push for our ability to operate at the top of our licenses. The The biggest challenge in opening a pharmacy versus pharmacy owners and leaders in other states are adbuying an existing one is patience. Patience for growth, vancing the profession by leading in advocacy, and their patience for advocacy, patience in building trust in your states allow them to practice to a standard of care. We customer base, and financial patience. It has given me definitely have a way to go with getting our state to a better respect for common terms we hear, such as understand our value and what positive impact we can “cash flow,” KPIs, inventory control, and just the day- have on patient outcomes if they would allow it. to-day business aspects that have to be considered in decision-making. There were days when I cried, days How do you engage with your community outside of when I thought it was not going to work, and even days routine dispensing activities? when I would spend hours trying to pinch every penny we could to keep the doors open. As the owner, one I serve on various boards, including the Marmust have the drive and consistency to show up even tin-Tyrell-Washington Board of Health and the Martin on the bad days. Community College. I am very involved as a volunteer member of our local Fire and EMS agency. We have What innovative ways have you adapted to changes in stepped out into the community to offer free classes community pharmacy/health care? about various topics such as Diabetes and Medicare insurance options. We travel to provide immunization We have brought every program and service to the ta- clinics. ble to drive positive patient outcomes and help solve patient problems. We have promoted patient packag- Impact/ Passion ing to every customer that has walked into the door. We have visited local offices to tell providers about our What impact do you hope to have on your patients and services. We are getting more involved with CPESN community? and learning great things from state leaders and innovators. We are using social media as an outlet for use- My most recent focus has been to change the narraful information and providing connections for pharma- tive on patient healthcare and get people to start makcy innovators in other states. We have recently been ing better health decisions now that will drive better inspired by the positive patient outcomes achieved healthcare outcomes for themselves in 10-20 years. through home blood pressure monitoring programs. We need to shift our focus from sick care and just taking medications to feel better in the moment, and Advocacy and Community Engagement start with basic nutritional support and overall healthPage 32

ier lifestyle choices that will drive macy in Robersonville, NC. They positive outcomes for wellness and opened for business on Septemlongevity. ber 12, 2023, and currently serve western Martin County, Stokes, and How do you envision the future of Bethel. https://leggettdrug.com/ community pharmacy? As independent pharmacies, we need to redirect the focus to getting people well for years to come. Focus on programs, supplements, and counseling to guide people toward better health. Think past the medications and start focusing on how to repair the things that are causing people to be sick and not well. We must set ourselves apart from the chains and, most recently, the quick and fast retail giant Amazon. What keeps you passionate about your work? Right now, passion is driven by positive patient outcomes. For me, it is the simple things, like getting people to make better dietary choices or getting outside for 10-15 minutes per day, being active, and seeing them light up with joy and enthusiasm when they take better care of themselves. What do you do to recharge outside of work? One of my most enjoyable ways to recharge outside of work is being on the water in the sunshine. I love water sports and spending time at my vacation home with my family. Sitting on my porch with a good book is a close second. Recently, I have been trying to get back into exercise and daily movement to help decrease the stress that comes with pharmacy ownership.

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Sunday Evening Webinars Join us October 18th for the October Sunday Evening Webinar, Beyond Fentanyl: Emerging Drugs, Drug Markets, and What Pharmacists Need to Know. North Carolina’s drug supply is changing rapidly, creating new challenges for overdose prevention, patient counseling, and harm reduction. Drawing on data from the UNC Street Drug Analysis Lab, this presentation will explore the state’s unregulated drug supply, from xylazine and medetomidine to emerging psychoactive substances. The session will examine drug market trends, how people and communities are adapting to a changing supply, and what pharmacists need to know to better support their patients. To learn more and register, visit our webpage. Opioid Stewardship in Action Series November 1st – Therapeutic Use of Buprenorphine for Pain: Evidence, Guidelines, and Clinical Decision Making. November 15, 2026 – Keep Your Brain in the Game: Preventing Meningococcal Disease December 13, 2026 – Premium Fuel: Harnessing the Power of Nutrition with GLP-1 Therapies Visit our webpage to register NCAP’s New Practitioner Forum’s Fall Webinars NCAP’s New Practitioner Forum has two opportunities planned for you to grow in your career and have fun at the same time. On Tuesday, October 27, 7 - 8 pm, join the virtual Tricks, Treats, & Career Feats for Halloween trivia, career Q & A, residency advice, and more! Register for this event here. On Tuesday, November 10 at 6:00 pm, join NPF as Stefanie

Ferreri, PharmD, leads a discussion of the book Hyperfocus: How to Work Less and Achieve More by Chris Bailey. Reading of the book is encouraged but not required. Register to join here. Health Systems and Hospital Pharmacists Huddle The NCAP-hosted “Huddle” is a virtual meeting held on the third Wednesday of every month. ​The meetings support open dialogue on topics important for health-system and hospital pharmacists and technicians serving in leadership and management roles. ​The meetings facilitate ​the sharing of ideas and solutions for common institution- and population- based operational, clinical, and financial challenges. Each meeting the ​agenda will be determined from the topics ​submitted by our ‘Huddle’ attendees. To learn more and join the meetings, go to our webpage. Ambulatory Care Pharmacists Huddle The NCAP-hosted “Huddle” is a virtual meeting held on the fourth Friday of every month. ​The meetings support open dialogue on topics important for ambulatory care pharmacy. ​The meetings facilitate ​the sharing of ideas and solutions for common ambulatory care matters. Each meeting will be opened by a “pearls” session or clinical case and the remainder of the ​agenda will be determined from the topics​ submitted by our ‘Huddle’ attendees. To learn more and join the meetings, go to our webpage. Sign Up for POCT Training – New Dates Available! NCAP, partnered with NASPA, brings you the Point-of-Care Test & Treat (POCT) Respiratory Certificate Program. There are a few new dates available: October 21, November 5, and December 3. All the information and the links to register are here on our website. Please, read all of the information carefully before registering. Let’s get you and your

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staff ready to better serve your patients during the 2026 influenza season. NCAP’s 2026 Residency Showcase Calling all 4th year pharmacy students and residency programs! This is the event where students can discover a large group of residency opportunities all in one place; and where residency programs can get a sneak peek at possible matches for their program needs. The Residency Showcase will be Saturday, November 7 from 10:30 am to 1:00 pm at the Union Square Campus in Greensboro, NC. Visit our website for more details and to register. Students don’t miss the chance to find the perfect next step for your career! 3rd year students and out of state students are welcome to attend.

sessions presented at convention; there were many more sessions presented by practitioners at the top of their field on hot topics of the year. AND we had an awesome evening with magician, Jack Kelly; he fooled Penn and Teller, and he fooled us, too! I share all of this to say we had an amazing convention this year. If you were there, you know it. If you weren’t there, make your plans to join us in 2027, June 16 18 at the Embassy Suites in Cary. It’s going to be great! Special Thanks to Our Convention Planning Committee A very special thank-you to the dedicated members of our 2026 Convention Planning Committee for helping make this year’s convention such a success:

NCAP Election Season is Here Members be sure to watch your emails around mid-October for the 2026 NCAP Election Ballot. This is your chance to help shape the leadership of the North Carolina Association of Pharmacists. If you will be one of the members running for election, good luck to you! Those elected will hold an important post, helping guide the future of the Association. If you would like to become more involved by serving on a practice academy leadership team or the Board of Directors, every summer we accept nominations. All members, pharmacists and pharmacy technicians, are eligible to serve on a leadership team.

Dave Phillips, Co-Chair Jennifer Davis, Co-Chair Dave Sugrue • Dustin Wilson • Carrie Baker • Mina Wolfe • Monica Dillingham • Kaileigh Yen Donation & Contribution Recognition We extend our sincere appreciation to the stores and organizations that generously donated prizes for our convention raffle. Your support helped make the event even more enjoyable for our attendees!

NCAP’s 2027 Annual Convention Save the date to join us for the 2027 NCAP Annual Convention, June 16 – 18, 2027 at the Embassy Suites Research Triangle in Cary, NC. Details will become available near the end of this year.

Bojangles Crowne Plaza Asheville Embassy Suites Cary First Horizon Coliseum – Greensboro Guilford and Main The Silver Gallery

2026 NCAP Annual Convention Wrap-Up

Thank you for supporting NCAP and our members!

Each year, the convention has special moments. This year, Chris Vasami, who played college baseball for Notre Dame and Elon University, going on to be drafted by and playing for the Colorado Rockies joined us. He shared with us his formula for unlocking our potential for greatness. We had Dr. Larry Greenblatt, NC DHHS State Health Director and Chief Medical Officer present to our group on rural health transformation. There were panel conversations. One with pharmacy leaders discussing transforming care for opioid use disorder in our state; the other, a group of pharmacy-championing legislators (Rep. Heather Rhyne, Sen. Gale Adcock, and Sen. Benton Sawrey) led in a discussion by Krystalyn Weaver, the Executive Vice President and CEO of NASPA. Dr. Weaver also presented on reimagining pharmacy with the standard of care. That is just a few of the

Congratulations to Our FNCAP Recipients! We are proud to recognize our 2026 FNCAP recipients: Allie Fay Olivia Caron Sacha Pollard-Deloney Tom D’Andrea Congratulations to all of our recipients, and thank you for your contributions to the profession of pharmacy!

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Visit ncpharmacists.org for more!

Category: Original Research Title: Association Between Pharmacist-Managed Pillbox Utilization and Hospitalization Rates Among Patients Enrolled in Chronic Care Management Authors: Ashley Bortlein, PharmD Institution: InClinicRx, Benson, NC Background: Medication-related problems contribute significantly to hospitalizations among patients with multiple chronic conditions. Hospitalizations are frequent, burdensome, and costly for older adults at increased risk for medication-related complications and care fragmentation. Chronic Care Management (CCM) services support this population through care coordination and longitudinal monitoring to improve outcomes and reduce avoidable healthcare utilization. Pharmacist-managed pillbox programs may complement these services by improving adherence and medication oversight, representing a potentially synergistic approach to reducing hospitalization risk. Objectives: The study will evaluate differing hospitalization rates in patients participating in both a pharmacist-managed pillbox program and/or CCM. Further, associative data among this study population will show changes in A1c and blood pressure in their respective cohorts. Methods: This retrospective cohort study will include patients enrolled in CCM, in which patients receiving pharmacist-managed pillbox services will be compared to CCM patients not receiving pillbox services. Hospitalization data will be obtained via a value-based care analytics platform. Additionally, the change in hemoglobin A1c among patients with diabetes and the change in systolic and diastolic blood pressure will be assessed via another value-based care analytic. Demographic and clinical variables will be collected

from the electronic health record. Multivariable regression will be used to assess the association between pillbox participation and hospitalization after adjustment for baseline characteristics. Results: Among 1,079 patients enrolled in CCM, 204 (18.9%) were utilizing pharmacist-managed pillbox services and 875 (81.1%) were not. Baseline demographic and clinical characteristics will be compared between groups. Analyses evaluating hospitalization rates and changes in hemoglobin A1c and blood pressure are currently in progress. Conclusion: This study will describe the integration of pharmacist-managed pillbox services within a chronic care management program and evaluate its association with hospitalizations and key clinical outcomes, offering guidance for healthcare teams aiming to enhance medication management for high-risk patients. Category: Original Research Title: Misused or Misunderstood? An Investigation in Prescription Drug Misuse Among College Students in North Carolina Authors: Ashlyn Hughes, Emily Qureshi, Kelsey McIntyre, Samual Niten, Shannon Langford, Edward Chiyaka, PhD Institution: Wingate University School of Pharmacy, Wingate, NC Objective: This study focuses on identifying the prevalence of prescription drug misuse, contributing factors, and knowledge and confidence levels of prescription drug use, disposal and storage techniques among college students in North Carolina. Methods: We implemented a cross-sectional survey study

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that included an educational intervention on prescription drug misuse. Following a pre-survey, a brief educational session was provided to participants on proper medication use, adherence, storage, and disposal, with participants completing the post-survey immediately thereafter. The pre- and post-survey assessed knowledge of medication misuse, adherence, storage, and disposal before and after the educational session. A total of 195 participants ranging from college freshmen to graduate students were included in the final analysis. Prescription drug use, disposal, and storage confidence measures were assessed on a five-point Likert scale. Results: Prevalence of misuse was initially 14.9%, however, following the educational session, the total reported prevalence was 26.2%, documenting an 11.3% increase from baseline. The most frequently reported contributing factors were pain relief, unaware of misuse and improved concentration. Following the educational session, a statistically significant increase in knowledge and confidence was noted in prescription drug storage (4.54 to 4.75; p < 0.001) and disposal (4.03 to 4.62; p < 0.001). Conclusion: The educational intervention highlighted a lack of awareness regarding prescription drug misuse and provided context on its definition. Following the educational session, students had an increased confidence and knowledge level for prescription drug storage and disposal techniques. Keywords: misuse, abuse, education, storage, adherence, disposal, college-aged, prescription drugs

Methods: An educational intervention covering the prevalence of CAB consumption among young adults as well as its effects and risks was developed. The educational intervention was delivered as either a 20-minute group presentation or a condensed 5-minute one-on-one session. Participants completed pre- and post-intervention surveys assessing knowledge and attitudes toward CAB use. A paired t-test was used to compare mean knowledge scores before and after the intervention. Results: Of the 118 individuals who participated, 94 completed both surveys and were included in the analysis. Mean knowledge scores increased from 54% (SD 21%) pre-intervention to 72% (SD 23%) post-intervention (p < 0.01). Self-reported knowledge increased from 32% to 95% of participants agreeing they were knowledgeable about the effects of combining alcohol and caffeine, while willingness to reduce CAB consumption increased from 66% to 80%. Conclusion: Findings of this study suggest that a brief educational intervention can improve knowledge about the risks of CAB use and increase openness to reducing consumption. Category: Original Research Title: Reimagining OTC Care: Patient Perspectives on Pharmacist Intervention, Monitoring, and Reimbursement Models Author: Cole Roberson, PharmD

Category: Original Research

Institution: InClinic Rx, Benson, NC

Title: Impact of a Community Health Education Intervention on Knowledge and Attitude Towards Caffeinated Alcoholic Beverage Use

Objective: Approximately 166.5 million adults in the United States report using at least one over-the-counter (OTC) medication or natural supplement within the past seven days.1 Many patients independently select and use these products without consulting a healthcare professional, potentially leading to inappropriate use, drug interactions, or adverse effects. The primary objective of this study is to evaluate patient perspectives on pharmacist intervention in selecting OTC products and identify common concerns among patients when choosing OTC medications or natural supplements. The study will further assess how pharmacists can support monitoring/follow-up through a Chronic Care Management (CCM) program while receiving reimbursement for their services.

Authors: Caleb Lanier, Ayanna Douglas, Riley Ferguson, Abby Marlowe, Jenna Overfelt, Amie J. Dirks-Naylor Institution: Wingate University School of Pharmacy, Wingate NC Objective: The objective of this study was to evaluate whether a brief educational intervention could improve knowledge of the risks associated with caffeinated alcoholic beverage (CAB) consumption and increase willingness to reduce CAB use.

Methods: A survey assessing patient perspectives and OTC

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utilization is currently ongoing. Participants are recruited from an independent pharmacy in Johnston County, North Carolina. Survey questions focus on current OTC use, categories of products used, and methods patients rely on when selecting OTC medications or supplements. Additionally, the survey evaluates patient attitudes toward pharmacist involvement, including reviewing OTC use alongside recent laboratory results, providing recommendations, and establishing routine monitoring to reduce risks and promote optimal utilization. Results: To date, 14 participants have completed the survey. Data collection is ongoing and will continue to be analyzed as participation increases. Preliminary findings suggest that patients underutilize pharmacists’ clinical expertise when selecting/managing OTC products. Respondents indicate a strong interest in pharmacist involvement, particularly in product selection, monitoring for adverse effects, and follow-up care. These findings support the development of a pharmacist-led model featuring routine evaluation of OTC use, lab monitoring, and structured follow-up, with potential for reimbursement via CCM workflow integration. Conclusion: This study highlights the value of pharmacist-led intervention in optimizing OTC medication and supplement use. Incorporating structured monitoring and follow-up services may improve patient safety, enhance outcomes, and provide a sustainable model for pharmacist reimbursement. 1. Green JL, Dailey-Govoni T, Kalidindi SD, Vosburg SK. Prevalence of Over-the-Counter and Prescription Medication Use in the US. JAMA Netw Open. 2026;9(2):e2559479. Published 2026 Feb 2. doi:10.1001/jamanetworkopen.2025.59479 Category: Quality Improvement Evaluations Title: Evaluation of Complement Inhibitor-Related Supportive Care in Patients with Paroxysmal Nocturnal Hemoglobinuria or Atypical Hemolytic Uremic Syndrome within an Academic Health System

and atypical hemolytic uremic syndrome (aHUS), requiring specific supportive care (vaccinations/infection prophylaxis). Additionally, many patients receiving eculizumab are eligible to switch to ravulizumab (less frequent administration). This study assessed supportive care practices associated with use of complement inhibitors across Atrium Health, including affiliated outpatient clinics and pharmacies. Identifying practice patterns, gaps, and standardization opportunities, this project sought to identify opportunities for future quality improvement initiatives focused on these high-risk, high-cost therapies. Methods: This multi-site, descriptive, retrospective chart review included patients of all ages with PNH or aHUS who received inpatient or outpatient eculizumab or ravulizumab within the Wake Forest and Charlotte Metro markets of Atrium Health from 1/1/2024 to 07/15/2025. Patients were identified through institutional medication-use records. Collected data included vaccination status, antimicrobial prophylaxis, current complement inhibitor therapy, eligibility for eculizumab-to-ravulizumab switch, and adverse events. The primary outcome was the percentage of patients receiving appropriate vaccinations; secondary endpoints included antimicrobial prophylaxis adherence, eligibility for therapy switch, and incidence of adverse events. Results: Out of twenty-six patients included, from 1/1/202407/15/2025, 13 patients received eculizumab, 18 received ravulizumab, five transitioned between the two. Six patients initiated therapy (one vaccinated prior to initiation, four (67%) completed meningococcal vaccination within six months, and five (83%) discharged from index hospitalization with appropriate antimicrobial prophylaxis). Seven patients experienced documented infections. At most recent clinic visit, 58% of all patients were up to date with meningococcal vaccination, 50% current on pneumococcal vaccination, and 35% current on both. Eleven patients (42%) received at least two doses of eculizumab and remained on active therapy, indicating potential transition to ravulizumab.

Authors: Samuel Sutton, PharmD Candidate; Juan Gomez Rios, PharmD Candidate; Deardra Lewis, PharmD Candidate, Paul C Parish, PharmD, BCOP

Conclusion: Vaccination and antimicrobial prophylaxis were used early, but long-term adherence remained low, supporting a population-wide quality improvement effort to boost persistence.

Institution: Atrium Health Wake Forest Baptist

Category: Original Research

Objective: Eculizumab and Ravulizumab are monoclonal antibody complement inhibitors, and critical therapies for patients with paroxysmal nocturnal hemoglobinuria (PNH)

Title: Impact of an Educational Intervention on College Students’ Knowledge and Consumption of Caffeine

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Authors: Dana Badran, PharmD Candidate, Gabrielle Bazemore, MBA, B.S., PharmD Candidate, Michael Cobb, A.S., PharmD Candidate, Zachary Hall, B.S., PharmD Candidate, Rama Ishnineh, PharmD Candidate, Priscilla Kuffour, B.S., A.S., PharmD Candidate, Melissa Dinkins, PharmD Institution: Wingate University School of Pharmacy Objective: Caffeine consumption is highly prevalent among college students and is often used to manage academic demands, despite associations with sleep disruption and adverse health effects. This study evaluated the impact of a brief, course-embedded educational intervention on college students’ knowledge, awareness, and self-reported caffeine consumption. Methods: This quasi-experimental study employed a preand post-survey design of undergraduate and graduate students enrolled in health-related courses at a private university in the southeastern United States. All students received a brief educational intervention consisting of a five-minute video on caffeine health effects, recommended intake limits, and caffeine content in common beverages, followed by a reflective caffeine-tracking assignment embedded in the course. Students who consented to participate in the research completed optional pre- and post-intervention surveys assessing caffeine knowledge, consumption behaviors, perceptions of dependence, readiness to change, and well-being. Quantitative data were analyzed using descriptive statistics and paired t-tests, and qualitative responses were analyzed thematically. Results: A total of 113 students completed the pre-survey, and 48 completed the post-survey. Following the intervention, students demonstrated increased awareness of caffeine intake, improved knowledge of caffeine-related health information, and reduced perceived dependence on caffeine. Performance on knowledge-based questions improved, particularly regarding the recommended timing of caffeine discontinuation before sleep. Qualitative findings indicated increased mindfulness of caffeine sources, surprise regarding cumulative intake, and intentions to reduce consumption among many participants. Differences in mental well-being were observed between undergraduate and graduate students. Conclusion: A brief, course-embedded educational intervention was effective in improving college students’ knowledge and awareness of caffeine consumption and prompted self-reflection regarding intake behaviors. These findings suggest that scalable, classroom-based educational strate-

gies may serve as a practical approach to promoting healthier caffeine-related behaviors on college campuses. Category: Quality Improvement Evaluation Title: A performance improvement project to quantify product abandonment of long-acting injectable (LAM) medications in a sample of outpatient behavioral health clinics in North Carolina* Authors: McKee Jerry1,3 , Reinstein Vera2, Wolfe Mina1 , Goodman Courtney 2 , Patel Ritesh4, Roberts Neal2, McCormick Charles2 Institution: 1North Carolina Association of Pharmacists, 2Alliance Health Plan, 3Wingate University School of Pharmacy, 4InClinic Rx *Project funded via Community Pharmacy Transformation Grant partnership between Alliance Health and NCAP Objective: Long-acting injectable behavioral health medications (LAMs) improve adherence and reduce total healthcare costs among individuals with severe mental illness or substance use disorder, yet remain underutilized due to systemic barriers. This project quantified LAM product abandonment with the “white bagging” model, defined as medications dispensed, billed, and delivered to clinics but not administered. Understanding abandonment is critical, as high-cost LAMs ($2,000–$3,000 per unit) represent significant financial waste. The study aimed to measure abandonment rates for antipsychotic and naltrexone LAMs across four rural North Carolina clinics (2024–2025). Methods: A pharmacy technician conducted a field assessment across four outpatient behavioral health clinics serviced by a single pharmacy. LAMs were dispensed and shipped to clinics one week prior to scheduled appointments. Clinic staff managed inventory and stored medications until administration. If unused within 30 days, LAMs were returned for destruction, as redispensing is prohibited by North Carolina regulations. Data on dispensed and unadministered LAMs, along with reasons for non-administration were collected and analyzed. Results: From January 1, 2024, to December 15, 2025, 1,726 LAMs were dispensed, of which 152 were not administered, yielding an abandonment rate of 8.8%. While over 90% of patients received treatment as intended, abandoned products represented $447,570 in costs based on Medicaid NADAC pricing. Given the controlled setting, this rate likely un-

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derestimates broader real-world abandonment. As unused medications cannot be reused or reimbursed, these costs represent direct financial loss. Conclusions: Extrapolated to Alliance Health’s CY2025 LAM spending ($40.6 million), abandonment could total $3.6 million annually. Transitioning 30% of administrations to a pharmacist-physician collaborative model with administration reimbursement increased to $55.81—where billing occurs only upon administration—could yield approximately $0.82 million in Medicaid savings while improving access. Additionally, pharmacist-administered models enhance adherence tracking through claims data, addressing limitations of the current white bagging system. Category: Original Research Title: Expanding Childhood Vaccine Access: Insights from Community Pharmacists in North Carolina During the COVID-19 Pandemic Authors: Amanda Savage, PharmD1, Macary Weck Marciniak, PharmD, BCACP, BCPS, FAPhA1, Yi- Fang (Ashley) Lee, MHA1, Yeshaben Patel, PharmD2, Sachiko Ozawa, PhD, MHS1,3 Institution: 1Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; 2Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC; 3Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC Objective: To examine the successes and challenges experienced by community pharmacists in North Carolina providing childhood and adolescent vaccinations during the COVID-19 pandemic and to characterize their knowledge, attitudes, and practices related to vaccine delivery. Methods: This qualitative study utilized semi-structured interviews with pharmacists practicing at sites that administered high volumes of COVID-19 vaccines between January 2021 and June 2023. Participants were identified using North Carolina Department of Health and Human Services vaccination data and recruited via email. Interviews were conducted virtually, recorded, and transcribed. An a priori codebook guided deductive and inductive coding. Thematic analysis identified key patterns and insights related to vaccine delivery in community pharmacy settings.

Results: Seventeen pharmacists participated, representing diverse geographic regions (59% rural) and pharmacy types (76% independent). Preliminary findings indicate that pharmacies served as critical access points for childhood and adolescent vaccination, particularly in underserved areas. Key facilitators included convenience, community trust, and the expanded authority under the Public Readiness and Emergency Preparedness Act. Pharmacy technicians played a vital role in supporting workflow and enabling high-volume vaccination efforts. Pharmacists reported increasing confidence over time despite initial hesitancy with vaccine administration for children and adolescents. Barriers included limited public awareness, workflow and staffing constraints, financial challenges (e.g. participation in the Vaccines for Children program), and policy-related limitations regarding vaccine compensation and Medicaid coverage changes. Community partnerships and culturally responsive outreach strategies enhanced vaccine uptake among vulnerable populations. Conclusion: Community pharmacies expanded access to childhood and adolescent vaccinations during the COVID-19 pandemic. Addressing financial, operational, and policy barriers is essential to sustain and scale pharmacy-based immunization services and improve equitable vaccine access across North Carolina. Category: Original Research Title: Health and Economic Impact of Pharmacy-Based COVID-19 Vaccination for Children and Adolescents in North Carolina Authors: Tatenda Yemeke1, Yi-Fang (Ashley) Lee1, Yeshaben Patel2, Colleen Higgins1, Anna Louise McNabb3, Jenny Myers3, Carrie Blanchard3, Amanda Savage1, Macary Weck Marciniak1, Sachiko Ozawa1,4 Institution: 1Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill NC; 2Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill NC; 3Division of Public Health, Epidemiology Section, North Carolina Department of Health and Human Services, Raleigh, NC; 4Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC Objective: To estimate the health and economic impact of pharmacy-based administration of COVID- 19 vaccines for

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children and adolescents in North Carolina. Methods: A county-level microsimulation model was developed to evaluate the impact of pharmacy- based COVID-19 vaccination among children aged 3-17 years from January 1, 2021, to June 26, 2023. Model inputs included vaccination data from the North Carolina COVID-19 Vaccine Management System, epidemiologic data from the North Carolina Department of Health and Human Services and Centers for Disease Control and Prevention, and hospitalization cost estimates. Outcomes were compared between a baseline scenario (vaccination by all providers, including pharmacies) and a counterfactual scenario (non- pharmacy providers only). Incremental differences were used to estimate the contribution of pharmacy-based vaccination. Model outputs were calibrated to observed state-level data. Results: During the study period, 843,001 children and adolescents received COVID-19 vaccines in North Carolina, with 42% administered in pharmacies. Pharmacy-based vaccination was associated with 38,537 fewer COVID-19 cases, 470 fewer hospitalizations (including 81 ICU admissions), and 5 fewer deaths. These health improvements translated to an estimated $14.7 million in total cost savings, including $10.9 million in avoided hospitalization costs and additional savings from reduced caregiver productivity losses. Pharmacies contributed substantially to vaccination across all geographic regions, with particularly strong impact in rural counties. Conclusion: Pharmacy-based vaccination significantly improved health outcomes and reduced healthcare costs for children and adolescents during the COVID-19 pandemic. Community pharmacies represent a scalable and accessible infrastructure to expand vaccine delivery. Category: Original Research Title: Review of urine drug screens for patients on buprenorphine-naloxone products at a family medicine office based opioid treatment program (FM OBOT). Authors: Maria Onusko, PharmD, Marcia Thacher, MD, Carriedelle Fusco, FNP, Nabarun Dasgupta, PhD, MPH, Olivia Caron, PharmD, BCACP, CPP Institution: MAHEC Family Health Center, Asheville, NC; UNC Chapel Hill, Chapel Hill, NC Objective: The purpose of this study was to examine levels of naloxone in confirmatory urine drug screens for patients taking sublingual buprenorphine-naloxone products

at a FM OBOT program. Secondary objectives: Examine characteristics for patients who reported withdrawal and/ or had naloxone present on confirmatory testing including renal function, liver function tests, concurrent use of benzodiazepines, dose of buprenorphine and naloxone, duration of treatment, other positive results on confirmatory drug screen, and other pertinent hepatic comorbidities. Methods: A registry for all patients at FM OBOT on buprenorphine-naloxone products between 5/1/2023 and 9/1/2024 was requested to identify the number of patients with naloxone present on confirmatory UDS. Two students extracted data points above in addition to the registry. Due to the number of patients with detectable naloxone levels, this project was expanded to a research analysis. IRB #2402187 was deemed exempt (March 2026). Analysis includes quantification of urine naloxone leakage, stratified by dose, frequency, and formulation. Results: 111 patients were identified as 18 or older and receiving combination buprenorphine-naloxone products with a confirmatory dominion UDS in the above dates. The average dose of buprenorphine was 18.7mg and average dose of naloxone was 4.7mg. Naloxone was detectable in 87.4% (97/111; 95% CI 79.9–92.3%); restricting to the 107 adherent patients yielded a sharper estimate of 90.7% (97/107; 95% CI 83.6–94.8%). Over half (52.3%) of adherent patients had urinary naloxone exceeding 500 ng/mL, and nearly one-third (31.8%) exceeded 1000 ng/mL. Our results found conditional on receiving a buprenorphine–naloxone product, no measured patient characteristic substantially predicts the magnitude of urinary naloxone. Conclusions: 91% of patients on buprenorphine-naloxone products had detectable levels of naloxone in their urine which supports use of the mono-product in patients reporting withdrawal symptoms or other adverse effects and suggests rethinking the assumption of negligible absorption for all patients. Category: Original Research Authors: Rena Whitfield, PharmD Title: Mobile Clinic Initiative to Improve Healthcare Access in Eastern Carolina Institution: Eastern Carolina Medical Center; InClinicRx Background: Access to timely, affordable healthcare remains a significant challenge for many residents in Eastern

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NC, particularly for uninsured individuals and those facing transportation, scheduling, or geographic barriers. Limited provider availability and difficulty attending appointments during standard clinic hours contribute to ongoing disparities in care. Mobile clinics offer a practical solution by delivering essential services directly to underserved communities. This initiative proposes a hybrid financial model that includes fee-for-service options for uninsured patients while billing insurance providers for covered individuals. Services will include vaccinations, chronic disease management, diagnostic testing, preventive screenings, and basic treatments, with the goal of improving healthcare accessibility and utilization.

concern in the United States, driven by high rates of prediabetes, obesity, and physical inactivity. Many at-risk individuals face barriers to preventive care, including limited access to structured programs and difficulty sustaining long-term lifestyle changes. The Centers for Disease Control and Prevention Diabetes Prevention Program (DPP) is an evidence-based initiative designed to reduce diabetes risk through community-based interventions.

Objectives: The initiative aims to: (1) assess community interest in a mobile clinic, (2) identify key barriers to healthcare access, and (3) evaluate the feasibility of a mobile clinic model to expand preventive and primary care services.

Methods: The CDC Diabetes Prevention Recognition Program (DPRP) is a year-long lifestyle intervention delivered by trained coaches through CDC-recognized organizations. Participants attend weekly sessions for 16 weeks, biweekly sessions for two months, and monthly sessions for six months. The program emphasizes healthy eating, at least 150 minutes of weekly physical activity, and a 5–7% weight loss goal, using strategies such as goal setting, self-monitoring, and peer support. It is offered in both in-person and virtual formats. Participants are weighed at each session (in-person or self-reported virtually), complete weekly activity logs, and have hemoglobin A1c measured quarterly through an in-house lab.

Methods: A three-month community needs assessment was conducted through surveys distributed to patients within a primary care clinic in Johnston County. The survey collected data on healthcare access, transportation, insurance status, scheduling challenges, and preferred clinic hours. Participants were specifically asked about their likelihood of using a mobile clinic operating monthly during evening hours (6:00–9:00 p.m.). Responses were analyzed using descriptive statistics. Results: Findings showed a strong interest in the mobile clinic. Major barriers identified included a lack of transportation, inability to miss work, and insurance challenges. Evening hours were highly preferred, offering flexibility for working individuals and caregivers. Conclusions: The proposed mobile clinic has potential to reduce healthcare barriers, improve preventive care, and enhance community health outcomes through accessible, flexible, and sustainable service delivery. Category: Original research Title: Exploring the clinical impact of a Pharmacist-led Diabetes Prevention Program Authors: Cole Roberson PharmD, Ashley Bortlein PharmD, Rena Whitfield PharmD Institution: Eastern Carolina Medical Center; InClinicRx Background: Type 2 diabetes is a growing public health

Objectives: The program aims to: (1) reduce the incidence of type 2 diabetes among individuals with prediabetes, (2) promote sustainable changes in diet and physical activity, and (3) Reduction in weight by 5%-7%

Results: Participation in the CDC DPP is associated with reduced risk of developing type 2 diabetes and lower A1c levels, along with improved weight management, healthier diets, and increased physical activity. Conclusions: The CDC DPP is a scalable, effective strategy for reducing diabetes risk. By supporting sustainable lifestyle changes and improving access to preventive care, it helps reduce the burden of type 2 diabetes. Category: Quality Improvement Evaluation Title: Pharmacist Impact on Lipid Management in Peripheral Arterial Disease Authors: Sara E. Bosek, PharmD, CPP; Kaitlyn Coggsdale, PharmD, CPP; Mattlyn Staley, PharmD, CPP; Kristin Bradley, PharmD, BCPS, CPP Institution: UNC Health Rex, Raleigh, NC Objective: Peripheral arterial disease (PAD) is linked to a threefold increase in all-cause mortality, yet management

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of key comorbidities such as lipid control, smoking cessation, and hypertension is often lacking. This study evaluated the effect of pharmacist involvement on guideline adherence and referral to a pharmacist-led lipid clinic for hyperlipidemia management in patients with PAD. Methods: Patients with hyperlipidemia and PAD referred to a pharmacist-led lipid clinic between October 1, 2024, and June 1, 2025, were included. This timeframe followed a pharmacist in-service presentation to vascular clinic providers in urban North Carolina, prompted by the release of updated PAD guidelines in May of 2024. Exclusion criteria were refusal of referral, missed visits, incarceration, pregnancy, breastfeeding, or LDL already at goal. The primary outcome was the percent change in LDL cholesterol at the first follow-up. Secondary outcomes included time to optimal LDL control, PAD-related hospitalizations, blood pressure (BP) control, and mean-time to smoking cessation. Results: Twenty-three patients met inclusion criteria. After one visit, mean LDL decreased by 34%. Fourteen patients (60.8%) initiated non-statin therapy, and eleven (78.5%) were initiated on a PCSK9 inhibitor. Most referrals (78.2%) occurred after provider in-service. Comorbid hypertension was common (91.3%), but only 30.4% achieved BP control at first visit. Three patients (13%) were smokers; all received counseling, with cessation averaging 32 days. Ten PAD-related hospitalizations occurred, attributed to two patients. Conclusion: Pharmacist-led management significantly improved LDL control. With most patients reaching goals after one visit. Increased referrals following provider education underscore the value of pharmacist in-services. Smoking cessation efforts were successful, but early hypertension control remains an opportunity for improvement. Category: Original Research Title: The Impact of Social Media on Mental Health Among College Students Authors: Sarah Voso, PharmD Candidate, Luiza Shepheard, PharmD Candidate, Andrea Cirocco, PharmD Candidate, Laurene Abaka-Mensah, PharmD Candidate, Sofia Popova, PharmD Candidate, Zachary Smyre, PharmD Candidate, and Edward T. Chiyaka, PhD, MSc Institution: Wingate University School of Pharmacy, Wingate NC Objective: Increased social media use among college stu-

dents is a growing global concern linked to declining mental health, including higher rates of depression, anxiety, and sleep disturbances. Among students with mental health disorders, only a third seek treatment, which can lead to negative consequences such as low academic performance, social isolation, and reduced physical activity. This study evaluated the impact of a brief educational session on social media use reduction on college students’ mental health outcomes and related knowledge. Methods: In this quasi-experimental pre-post study, 82 undergraduate and graduate university students aged 18 and older completed a baseline survey containing demographic and mental health questionnaires (PHQ-9, GAD-7, and SCI). They attended a brief educational presentation on the effects of social media use on mental health outcomes and were encouraged to reduce their social media usage. After four weeks, participants completed a post-survey to compare changes in social media use, mental health, and knowledge from baseline. Results: The brief educational intervention significantly reduced social media use by approximately 5 hours (p < .001) and increased participants’ belief that social media can negatively affect mental health outcomes (4.06 ± 0.95 to 4.29 ± 0.78; p = .036). Additionally, trends of lower depression, anxiety, and insomnia rates were noted after the intervention. Conclusion: These findings provide a greater understanding of social media’s negative impact on college students’ mental health and suggest that educational and screentime use interventions may improve outcomes among this population. Category: Original Research Title: Educating adults on safe and effective use of nonprescription medications for cough and cold symptoms Authors: Janna Hope Laney, PharmD Candidate1, Clarence Lazelle Smith, II, B.S., PharmD Candidate1, Grace Virginia Pryor, B.S., PharmD Candidate1, Yuktiben Yogeshkumar Shah, B.A., PharmD/MBA Candidate1, Sarah Jane Wrenn, PharmD Candidate1, and Melissa McCall Dinkins, PharmD1 Institution: Wingate University School of Pharmacy, Wingate NC Background: Studies indicate that consumers frequently misinterpret information on the FDA-mandated Drug Facts

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Label of nonprescription products, including identifying active ingredients, detecting duplicate therapy, matching symptoms to indications, and applying warnings to comorbidities or concomitant medications. An educational intervention about the nonprescription Drug Facts Label was designed to increase understanding of safe and effective use of cough and cold nonprescription medications and consumer confidence in selecting products. Methods: This pre-post interventional study was conducted among participants in rural North Carolina counties. Participants completed a pre-survey to evaluate baseline knowledge of the Drug Facts Label, including active ingredients, indications, and medication avoidance with certain conditions. They then received a brief educational intervention from an educational brochure delivered by pharmacy students. A post-survey immediately followed to measure knowledge retention and understanding. Results: Eighty-six participants completed both surveys. Average knowledge scores increased from 3.59 to 4.21 out of 5 (p < 0.05). Confidence in selecting nonprescription cough and cold products increased from 36% to 74%. The most notable improvement was in correct identification of active ingredients (from 73.3% to 94.2%). Conclusion: This study found that a brief, student pharmacist-led educational intervention significantly improved both confidence and knowledge related to the safe and effective use of nonprescription cough and cold medications. Category: Original Research

underserved communities to promote early recognition. Methods: Six pharmacy students delivered one‑on‑one and group educational sessions at various venues using standardized materials, including pamphlets, poster boards, and a narrative case titled “Recognizing the Signs: Bella’s Story.” The story illustrated the progression of unrecognized T1DM leading to complications, and discussions about common symptoms, risk factors, and management. Participants completed pre‑ and post‑surveys assessing demographics, knowledge, confidence, and perceived awareness. Pre- and post-survey responses were scored on a 10-point scale. Mean scores were calculated and compared using a paired t-test to assess differences in participant knowledge before and after the educational intervention. Results: A total of 124 individuals attended the sessions, with 100 completing both surveys. Most participants (76%) reported no prior T1DM education. Mean knowledge scores were 54.41% + 24.19 vs 87.47% + 16.32, pre- vs post-survey, respectively, with increases observed across all knowledge‑based questions. Participants demonstrated substantial gains in self‑reported familiarity with symptoms, confidence in recognizing warning signs, and awareness of reliable information sources. Approximately 89.5% of participants indicated that the storytelling method was effective, and 86.7% reported learning new information. Conclusion: These findings suggest the storytelling method is an effective means of education for understanding complex health concepts.

Title: A Storytelling Approach to Type 1 Diabetes Mellitus Community Health Education: Effects on Knowledge, Awareness, and Confidence in Underserved Populations to Promote Early Recognition Authors: Kaleigh Baisden, Kaley Deese, Nour Abodabba, Mohamed Algazali, Richard Martin Jr., Zoey Adams, Amie Dirks-Naylor Institution: Wingate University School of Pharmacy, Wingate, North Carolina, United States Objective: The incidence of Type 1 Diabetes Mellitus (T1DM) has increased worldwide over recent decades. Early disease recognition reduces the occurrence of complications. This study aimed to determine if a community health education intervention utilizing a storytelling teaching method could increase knowledge and awareness regarding T1DM among Page 49