Proper disposal of controlled substance medications, a legally gray area since the Controlled Substance Act of 1970 was passed, has received renewed attention in recent years because of an increase in deaths related to opioid pain reliever (OPR) overdoses and increased nonmedical use of OPRs.1,2 Prescription drug take-back events have been organized under the purview of the Drug Enforcement Administration (DEA) to properly dispose of controlled substance medications; to decrease prescription medication diversion, abuse, and accidental poisonings; and to decrease environmental hazards resulting from improper medication disposal. The DEA has reported pounds of medications in aggregate donated at take-back events but has not examined the extent to which OPRs are being donated at these events.3 We analyzed the characteristics of donors and medications donated at 11 take-back events in rural Appalachia, an area struggling with disproportionately high rates of OPR nonmedical use and abuse.

Pharmacists’ ability to interfere with prescription drug abuse is hindered back a lack of confidence, training, and time.

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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Abstract available through Pharmacotherapy.

Prescription drug abuse (PDA) is an epidemic nationwide and has disproportionally impacted the Southern Appalachian region. Situated within a geographic area known for pervasive PDA and its consequences, The Gatton College of Pharmacy and Academic Health Sciences Center (AHSC) at East Tennessee State University are proactively engaging the Region and its health professions students to address the problem. Over the College’s six-year history of community engagement in PDA, efforts have focused on primary prevention activities, PDA treatment, awareness, education, and interprofessional collaboration as the key impact sectors. Notable programs include Generation Rx, Operation Rx Disposal, continuing education (CE) programming, and establishment of the ETSU Diversity-promoting Institutions Drug Abuse Research Program. In 2013-2014, 3 faculty and 38 Generation Rx pharmacy students engaged 4000 children and adolescents in PDA prevention education. Operation Rx Disposal employed 5 faculty members and 35 student pharmacists to assist more than 1000 households in removing unwanted medication from their homes through conduction of drug take-back events. Over 2000 health care providers from regional communities participated in PDA CE events conducted by 3 pharmacy faculty members. Additionally, 3 externally funded, PDA-specific grants totaling $2.26 million were awarded to pharmacy faculty members to engage communities, health care professionals, and students in innovative PDA prevention research. The College’s efforts have been nationally recognized by peers, professional organizations, state boards of pharmacy and within the evidentiary literature.

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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