Dr. Robert Pack, associate dean for Academic Affairs in ETSU’s College of Public Health, joined leaders from public health schools in four other states in the Appalachian region to discuss with members of the U.S. Congress the complex and dynamic processes at work in the opioid crisis. Pack joined his colleagues in sharing findings on unique approaches to address the course of the epidemic as well as discuss how university-based public health experts are assisting affected communities by bringing traditional and novel epidemic control strategies to bear on the disease.

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This seminar will focus on the problem of prescription and other opioid abuse in Appalachia. Topics include epidemiology of the problem, a model for understanding the scope and complexity of the problem and key lessons learned in Tennessee. The presentation will conclude with a discussion of current efforts to address the problem by groups in the NE Tennessee and SW Virginia region.

Context: Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and dispenser health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research is lacking on HCP PDA communicative behavioral engagement and factors that influence it. Objective: To describe PDA-related communicative behaviors and perceptions of primary care prescribers and community pharmacists. Design: Qualitative, semi-structured interprofessional and profession-specific focus groups were conducted, transcribed, coded, and thematically analyzed by two researchers. Established communication domains (communication apprehension, self-perceived communication competence, and willingness to communicate) guided focus group interviews. Setting: Appalachian Research Network (AppNET) PBRN clinics and communities. Participants: AppNET primary care prescribers (N=19) and community pharmacists (N=16). Main and Secondary Outcome Measures: Inductively derived themes resulting from focus groups. Results: Twelve themes were noted across two communication domains: HCP-patient communication (N=6) and HCP-HCP communication (N=6). HCP-patient communication engagement was influenced by multiple patient factors, with objective data (e.g., urine drug screens, distance travelled to practice) weighed heavily. Multiple practice barriers to communication were noted, including time pressures and a lack of screening resources. Difficult or uncomfortable conversations were often avoided by HCPs and substituted with simplified prescribing/dispensing conversations or policies. Dispenser to prescriber and prescriber to dispenser communication was described as rare and often perceived to be ineffective. Counter-intuitively, prescriber to dispenser communication was reported to have decreased after implementation of state prescription drug monitoring programs. Dispensers reported not being perceived as colleagues or teammates to prescribers in prescription drug abuse prevention and treatment. Prescribing behaviors were often questioned by dispensers, and some prescribers questioned dispensing behaviors. Conclusions: HCP prescription drug abuse communication is situational and influenced by patient, practice, and HCP characteristics. Identified themes will inform development of PDA-specific communication assessments that can be used to target and evaluate PDA communication interventions.

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Purpose: Prescription and illicit opioid abuse have disproportionately impacted the Central Appalachian Region. Centers for Disease Control and Prevention (CDC) data indicate the region is home to many of the 220 counties most vulnerable to rapid dissemination of Hepatitis C Virus (HCV) and HIV related to injection drug use. Growing evidence supports the role of community pharmacies in HCV/HIV prevention by providing access to non-prescription sterile syringes; however, research has largely been confined to major metropolitan areas. The objective of this study is to evaluate the feasibility of community pharmacies in Central Appalachia serving as access points for sterile syringes. Methods: This study was approved by the Institutional Review Board. Using state directories of health professionals, community pharmacists from Northeast Tennessee, Western North Carolina, and Southwest Virginia were randomly selected to participate in key informant interviews to inform understanding of the impact of attitudes, beliefs, and state-level policies on pharmacists’ syringe dispensing behaviors (N=15). Informed consent was obtained prior to initiating the interviews and participants were provided modest compensation for their time. The semi-structured interviews were guided by Theory of Planned Behavior constructs to focus the interview on evidence-based predictors of behaviors. Interviews were audio-recorded, de-identified, transcribed, and are currently being thematically analyzed by the research team with NVivo software. The results of this study are expected to inform development of a survey instrument for a larger quantitative evaluation of pharmacists' perceptions on syringe dispensing in the region. Results: Not applicableConclusion: Not applicable

Opioid analgesics are commonly used to treat acute and chronic pain; in 2016 alone, more than 60 million patients had at least 1 prescription for opioid analgesics filled or refilled. Despite the ubiquitous use of these agents, the effectiveness of long-term use of opioids for chronic noncancer pain management is questionable, yet links among long-term use, addiction, and overdose deaths are well established. Because of overprescribing and misuse, an opioid epidemic has developed in the United States. The health and economic burdens of opioid abuse on individuals, their families, and society are substantial. Part 1 of this supplement will provide a background on the burden of pain and the impact of opioid abuse on individuals, their families, and society; the attempts to remedy this burden through prescription opioid use; and the eventual downward spiral into the current opioid epidemic, including an overview of opioid analgesics and opioid use disorder and the rise in opioid-related deaths