Pharmacists' attitudes toward dispensing naloxone and medications for opioid use disorder: A scoping review of the literature.
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2019-08-16
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Abstract
Background: Pharmacists are on the frontline caring for patients at risk of an opioid overdose and for patients with an opioid use disorder (OUD). Dispensing naloxone and medications for OUD and counseling patients about these medications are ways pharmacists can provide care. Key to pharmacists' involvement is their willingness to take on these practice responsibilities. Methods: The purpose of this scoping review is to identify, evaluate, and summarize published literature describing pharmacists' attitudes toward naloxone and medications for OUD, i.e., methadone, buprenorphine, and naltrexone. All searches were performed on December 7, 2018, in 5 databases: Embase.com, PubMed.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost, Cochrane Central Register of Controlled Trials via Wiley, and Clarivate Web of Science. Articles included original research conducted in the United States, described attitude-related language toward naloxone and medications for OUD, and pharmacists. Results: A total of 1323 articles were retrieved, 7 were included. Five studies reported on pharmacists' attitudes toward naloxone dispensing, 1 study reported on attitudes toward naloxone, buprenorphine, and buprenorphine/naloxone, and 1 reported on attitudes toward buprenorphine/naloxone. Respondents were diverse, including pharmacists from different practice specialties. Studies found that pharmacists agreed with a naloxone standing order, believed that naloxone should be dispensed to individuals at risk of an opioid overdose, and were supportive of dispensing buprenorphine. A minority of pharmacists expressed negative attitudes. Barriers cited to implementation included education and training, workflow, and management support. Conclusions: Pharmacists were positive in their attitudes toward increased practice responsibilities for patients at risk of an opioid overdose or with an OUD. Pharmacists must receive education and training to be current in their understanding of OUD medications, and they must be supported in order to provide effective care to this patient population.
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Muzyk, Andrew, Zachary PW Smothers, Kathryn Collins, Mark MacEachern and Li-Tzy Wu (2019). Pharmacists' attitudes toward dispensing naloxone and medications for opioid use disorder: A scoping review of the literature. Substance abuse. pp. 1–8. 10.1080/08897077.2019.1616349 Retrieved from https://hdl.handle.net/10161/19269.
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Andrew Muzyk
Dr. Andrew Muzyk is an Associate Professor of the Practice of Medical Education at Duke University School of Medicine and an Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences. He also holds a Clinical Associate appointment in the Duke University School of Nursing. He teaches pharmacology across health professions programs, rounds as a clinical pharmacist on the Medicine-Psychiatry service at Duke University Hospital, and conducts educational and health services research.
Teaching
At Duke University School of Medicine, Dr. Muzyk is the course director for the Foundations of Patient Care II course, which integrates pharmacology, pathology, microbiology, immunology, and clinical medicine, in the first-year medical school curriculum. Within this course he also serves as the content director for pharmacology and clinical medicine. He lectures extensively in the first-year medical student curriculum with a focus on pharmacology, psychopharmacology, and substance use disorder treatment. At Duke University School of Nursing, Dr. Muzyk is the co-course director for the Understanding Substance Use Disorders course in the Accelerated Bachelor of Science in Nursing program. Dr. Muzyk previously directed and taught in the Biological Psychiatry course for Duke psychiatry residents.
At Campbell University College of Pharmacy and Health Sciences, he teaches pharmacotherapy with an emphasis on psychiatric, neurologic, and substance use disorders to second-year pharmacy and first-year physician assistant students. He is a course director for the Neurology-Psychiatry and Health Informatics I & II courses. Dr. Muzyk precepts fourth-year pharmacy students and pharmacy residents completing their internal medicine and psychiatry clinical rotations at Duke University Hospital. He mentors graduate students in the University of Michigan’s Master of Health Professions Education program.
Clinical Practice
Dr. Muzyk practices as a clinical pharmacist on the Medicine-Psychiatry inpatient service at Duke University Hospital, specializing in the care of patients with co-occurring medical and psychiatric conditions, substance use disorders, and complex psychopharmacology needs. He also provides psychopharmacology expertise to the Psychiatry Consult Service and the Caring for Patients with Opioid Misuse through Evidence-Based Treatment team.
Scholarship
Dr. Muzyk has authored more than 80 peer-reviewed publications addressing health professions education, psychopharmacology, and hospital-based medication outcomes. His research has appeared in journals such as Academic Medicine, Substance Abuse, Psychosomatics, Academic Psychiatry, American Journal of Pharmaceutical Education, CNS Drugs, and Pharmacotherapy. He has secured over $250,000 in research and educational funding, including support from the National Institute on Drug Abuse, Duke Academy for Health Professions Education and Academic Development, Duke Division of Addiction Medicine, Duke Bass Connections, the Josiah Charles Trent Memorial Foundation, and Campbell University. His impact is reflected by a ResearchGate score of 759.7, over 1,519 citations, and an h-index of 25. Dr. Muzyk has authored two textbook chapters, given 53 poster presentations, reviewed manuscript submissions for 40 journals, and served on the editorial board for Primary Care Companion for the Journal of Clinical Psychiatry. He has delivered more than 300 continuing education lectures, grand rounds, workshops, and symposia at the local, regional, and national level.
Awards
Dr. Muzyk’s contributions have been recognized with numerous honors, including the Dean’s Award for Excellence in Teaching and Educator of the Year award from Campbell University, the Association of American Medical Colleges Curricular Innovation Award, the Association for Multidisciplinary Education and Research in Substance Use and Addiction New Educator/Investigator Award, the Duke University Hospital Educator and Researcher of the Year Award, the Duke AHEAD Interprofessional Excellence Award, the Association of Academic Psychiatry Psychiatric Education Award, and the North Carolina Association of Pharmacists Distinguished Young Pharmacist Award.
Education and Training
Dr. Muzyk earned his PharmD from Mercer University College of Pharmacy. He completed two years of residency training, culminating in a psychiatric pharmacy residency at UNC Medical Center. He received his Master of Health Professions Education from the University of Michigan and completed a two-year Climate Health Organizing fellowship through Harvard Medical School and Cambridge Health Alliance.
Li-Tzy Wu
Education/Training: Pre- and post-doctoral training in mental health service research, psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute on the Design and Conduct of Randomized Clinical Trials.
Director: Duke Community Based Substance Use Disorder Research Program.
Research interests: COVID-19, Opioid misuse, Opioid overdose, Opioid use disorder, Opioid addiction prevention and treatment, Pain and addiction, Chronic diseases and substance use disorders, diabetes, pharmacy-based care models and services, medication treatment for opioid use disorder (MOUD), Drug overdose, Polysubstance use and disorders, cannabis, alcohol, tobacco, hallucinogens, stimulants, e-cigarette, SBIRT (substance use Screening, Brief Intervention, Referral to Treatment), EHR-based research and intervention, data science, psychometric analysis (IRT), epidemiology of addictions and comorbidity, behavioral health care integration, health services research (mental health disorders, substance use disorders, chronic diseases), nosology, research design, HIV risk behavior.
FUNDED Research projects (Principal Investigator [PI], Site PI, or Sub-award PI):
R03: Substance use/dependence (PI).
R21: Treatment use for alcohol use disorders (PI).
R21: Inhalant use & disorders (PI).
R01: MDMA/hallucinogen use/disorders (PI).
R01: Prescription pain reliever (opioids) misuse and use disorders (PI).
R01: Substance use disorders in adolescents (PI).
R21: CTN Substance use diagnoses & treatment (PI).
R33: CTN Substance use diagnoses & treatment (PI).
R01: Evolution of Psychopathology in the Population (ECA Duke site PI).
R01: Substance use disorders and treatment use among Asian Americans and Pacific Islanders (PI).
UG1: SBIRT in Primary Care (NIDA, PI).
UG1: TAPS Tool, Substance use screening tool validation in primary care (NIDA, PI).
UG1: NIDA CTN Mid-Southern Node (Clinical Trials Network, PI).
UG1: EHR Data Element Study (NIDA, PI).
UG1: Buprenorphine Physician-Pharmacist Collaboration in the Management of Patients With Opioid Use Disorder (NIDA, PI).
PCORI: INSPIRE-Integrated Health Services to Reduce Opioid Use While Managing Chronic Pain (Site PI).
CDC R01: Evaluation of state-mandated acute and post-surgical pain-specific CDC opioid prescribing (Site PI).
Pilot: Measuring Opioid Use Disorders in Secondary Electronic Health Records Data (Carolinas Collaborative Grant: Duke PI).
R21: Developing a prevention model of alcohol use disorder for Pacific Islander young adults (Subaward PI, Investigator).
UG1: Subthreshold Opioid Use Disorder Prevention Trial (NIH HEAL Initiative) (NIDA supplement, CTN-0101, Investigator).
NIDA: A Pilot Study to Permit Opioid Treatment Program Physicians to Prescribe Methadone through Community Pharmacies for their Stable Methadone Patients (NIDA/FRI: Study PI).
UG1: Integrating pharmacy-based prevention and treatment of opioid and other substance use disorders: A survey of pharmacists and stakeholder (NIH HEAL Initiative, NIDA, PI).
UG1: NorthStar Node of the Clinical Trials Network (NIDA, Site PI).
R34: Intervention Development and Pilot Study to Reduce Untreated Native Hawaiian and Pacific Islander Opioid Use Disorders (Subaward PI, Investigator).
UG1: Optimal Policies to Improve Methadone Maintenance Adherence Longterm (OPTIMMAL Study) (NIDA, Site PI).
R01: Increasing access to opioid use disorder treatment by opening pharmacy-based medication units of opioid treatment programs (NIDA, PI)
R01: Preventing Alcohol Use Disorders and Alcohol-Related Harms in Pacific Islander Young Adults (Subaward PI, Investigator).
R01: Understanding the short- and long-term effects of the COVID-19 pandemic on the overdose crisis (Subaward PI, Investigator).
UG1: Northstar Node of The Clinical Trials Network (Subaward PI, Investigator).
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