Prescription drug abuse is a major public health problem in United States. Research showing 70% of nonmedical prescription drug users obtain drugs from friends and family has sparked discussion over disposal of unused or expired medications. Tennessee experienced a 250% increase in overdose deaths from 2001 to 2010. In response to this increase, permanent drug donation receptacles have been installed in multiple law enforcement offices across the state; however, the extent to which the public utilizes these receptacles is not well known. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations were analyzed in six Northeast Tennessee locations from June 2012 to October 2013. The objectives of this research were to: 1) quantify controlled substances (CS) donated, and 2) evaluate time lapse between dispensing date and donation across CS schedules as well as potency rankings for opioids. Over the 18-month collection period, 3,113.5 lbs. of pharmaceutical waste was donated; 5.14% or 160lbs were CS, totaling 65,430 individual doses. Analysis of dispensing dates for CS medications indicated a median of 34 months lapsed from dispensing to donation (range 1 to 484 months). Comparison of means between Schedule II and Schedule III/IV indicated that Schedule II drugs were donated within fewer months than Schedule III/IV drugs (t-test = -4.37, p-value <0.0001). These results quantify the potential impact of permanent drug donation boxes on the prevention of CS diversion in Northeast Tennessee. Further study is warranted to examine the effect of targeted public health messages on increasing CS donation.

Introduction: Community pharmacists in the United States routinely serve as intermediaries in the process of providing (i.e., dispensing) prescription opioids (POs) to patients for whom they are prescribed. Similar to most states, Tennessee (TN) has experienced exponential increases in PO dispensing, abuse and overdose deaths over the past decade. A multifaceted approach has been put forth by the United States National Drug Control Strategy to combat PO abuse, one aspect of which is expanding the extent to which health care professionals detect and address substance use disorders. Despite little exploration of pharmacist provided PO abuse/misuse interventions, our previous research reveals that 26% of TN community pharmacists have provided addiction treatment facility information to one or more patients in the past, and 13% of pharmacists have addiction treatment facility information in their pharmacies. The objective of this study is to investigate the associations between community pharmacist and community pharmacy characteristics and the provision of addiction treatment facility information to pharmacy patients. Methods: A survey was administered to a stratified random sample of licensed TN pharmacists in 2012 using Dillman’s Tailored Design Method. The survey instrument assessed community pharmacists’ attitudes, beliefs and behaviors specific to prescription drug abuse communication. Logistic regression techniques were used to identify correlates of provision of addiction facility information by pharmacists. Results: A response rate of 40% was obtained. Univariate logistic regression analysis indicated the provision of addiction treatment information was associated with being male, increased average number of hours worked per week, having addiction treatment information readily available in the pharmacy, higher self-efficacy beliefs regarding ability to discuss addiction treatment facility options, discuss perceived PO abuse, and discuss perceived PO addiction with patients, participation in PO abuse specific continuing education (CE), and employment in an independent pharmacy setting. Multiple logistic regression analysis indicated that being male (OR = 2.2; 95% CI = 1.4-3.6), having high task-specific self-efficacy beliefs (OR = 4.2; 95% CI = 2.7-6.5), working more hours (OR = 1.00; 95% CI = 1.02-1.05), participating in prescription drug abuse-related CE (OR = 2.9; 95% CI = 1.7-5.0), and having treatment facility information in the practice setting (OR = 8.2; 95% CI = 4.4-15.4) were statistically significant predictors of information provision. Implications: As interventions and models are developed that expand prevention and treatment efforts, factors should be considered that influence health care providers’ prescription drug abuse/misusedeterrent behaviors. Our research has the potential to inform these interventions and thereby expand the extent to which community pharmacists engage in the detection and care of patients with substance use disorders.

Naloxone has received increased public health attention in recent years given its effectiveness in the reversal of opioid overdoses. Despite continued increases in overdose death rates attributable to opioids, approaches to naloxone dissemination, prescribing and dispensing are quite variable across states. On the public health prevention continuum, naloxone dissemination and use could be considered quaternary prevention —actions taken to identify individuals at risk of over-medication, protect them from new medical invasion and suggest interventions which are ethically acceptable. This presentation will describe approaches to overdose death prevention with naloxone in four states: Maine, Tennessee, Texas and Virginia. Particular emphasis will be placed on the role of community pharmacies in increasing naloxone dissemination. Attendees will be informed about recent legislative, educational and profession-specific prevention strategies and will thereafter engage in active learning to apply prevention strategies in their respective states. In addition to discussing barriers to and suggestions for increased naloxone uptake, presenters will describe assessments that can be used to evaluate overdose risk and subsequent naloxone co-prescribing/dispensing.

Controlled substance stewardship, much in the same vein as antimicrobial stewardship, is a professional obligation for prescribers and pharmacists alike in today’s practice environment. This presentation will introduce this concept and present a model for pharmacist-led controlled substance prescribing interventions in a primary care clinic. The Controlled Substances Initiative (CSI) at Penobscot Community Health Care in Bangor, Maine, was implemented in 2013. The interprofessional CSI Committee meets weekly to review patient cases involving controlled substances and communicate best practice recommendations to prescribers. All committee operations are sustained by pharmacists participating in a postgraduate residency training program. To assess the organization-wide impact of the initiative, presenters will share data on controlled substance dose reductions and mortality trends. They will offer pearls for application of this model to other practice settings, including community pharmacies.

Rates of prescription drug misuse in Texas are alarmingly high. One in five Texas high school students have taken prescription drugs without a doctor’s prescription. In 2015, Texas had the second highest total healthcare costs from opioid abuse in the nation ($1.96 billion), and Texas is home to four of the top 25 cities in the U.S. for opioid abuse. Meanwhile, only one in three prescribers is using the statewide Prescription Drug Monitoring Program (PDMP), leading to a massive loss of data. There is substantial need for increased infrastructure and prevention measures in Texas, especially related to the emergence of prescription drug misuse. This panel will describe the current landscape of prescription drug misuse and its consequences, discuss strategies to turn down misuse, and explain the proactive approach Texas is taking to enhance misuse prevention and data infrastructure across the state.

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