Prescription drug abuse and misuse (PDA/M) prevalence has increased dramatically in the United States over the last two decades. Community pharmacists are intimately involved in the dispensing of a majority of eventually abused/misused prescription drugs and are thus well positioned to engage in PDA/M prevention and treatment. A known barrier to engagement in prevention efforts among providers is discomfort with PDA/M communication. The objective of this study was to explore relative situational self-perceived PDA/M communication confidence among Tennessee community pharmacists. Using the validated Self-Perceived Communication Competence instrument as a framework, an 18-item survey instrument (0-100 scale; 0=completely unconfident, 100=completely confident) was developed and administered to 2000 Tennessee pharmacists. Items elicited communication confidence across multiple contexts and receivers, including PDA/M situations and common community pharmacy situations. Parametric statistical tests were used to examine differences in communication confidence across demographic variables. A 40% response rate was obtained. Mean self-perceived communication confidence ratings ranged from 54.2 to 92.6. Statistically significant differences were noted across receiver type and context. Addiction communication confidence was significantly lower than all other scenarios involving patient communication, including items that could be considered accusatory to patients (non-adherence, smoking cessation). Differences in communicative self-confidence were noted across gender, practice setting, years in practice, hours worked per week, and number of prescriptions filled per week. Pharmacists’ self-perceived communication confidence is situational and varies across pharmacist and practice setting characteristics. Efforts to engage community pharmacists in PDA/M prevention and treatment should foster development of communicative self-confidence across multiple PDA/M situations.

Objectives: 1) To describe the interprofessional implementation process and programmatic outcomes of an inaugural drug take-back event on a university campus; 2) To quantify donated medications and summarize donor demographics. Method: East Tennessee State University (ETSU) affiliated colleges, campus organizations, research teams, law enforcement and other community partners collaborated to host the inaugural live drug take-back event on ETSU’s main undergraduate campus. Programmatic outcomes included the number of community stakeholders, ETSU participating colleges, student donors, and donated medication metrics, including controlled substance medications. All donated medications were quantified by drug name and controlled substance schedule. Donor demographic information and perceptions of drug abuse on campus were collected using a brief survey. Results: Fifty pounds of medications were collected for disposal by 42 donors (9 students; 33 non-students). Controlled substances accounted for 8% of donated medications. Nearly 80% of student donors were enrolled in Academic Health Science Center colleges. Aggregate survey results indicated concerns about prescription drug abuse and misuse on campus. Three faculty members, two research fellows, two doctoral students, three graduate assistants and eight professional students from ETSU’s Colleges of Pharmacy and Public Health, as well as additional staff members, represented the contributing community entities and colleges during the live event. Implications: Conduction of drug take-back events on a university campus can promote interprofessional public health interventions and simultaneously reduce opportunities for nonmedical use of prescription drugs in college students. Further research is warranted to establish best practices and maximum impact for college-based take-back events.

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.

Excerpt:Misperceptions about personal weight are common and include both under- and overestimates.1–6 Overweight misperception is found among both males and females across different racial/ethnic and age groups but is generally more common among females. Studies also indicate that body weight misperception is common among university students.2,4,7,8 In a study assessing the prevalence of weight misperception among U.S. college students, 12.9% of students had inflated body weight perception and 15.1% considered themselves to be thinner than they actually were.7 Gender and racial/ethnic differences in weight misperception have been observed among normal-weight college adults. According to the 2008 National College Health Assessment (NCHA), 28.8% of college females and 39.4% of college males were overweight or obese. However, more females (38.0%) than males (30.8%) described themselves as overweight or obese.8 Non-Hispanic white people are also more likely to report overweight misperception than other racial/ethnic minority groups.8,9

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.