In its inaugural year, The Mental Health Clinician published an excellent issue with articles devoted to substance use disorder. In this issue, the theme once again centers on substance use disorder. With a case report and literature reviews, our article focus has shifted this time around to explore pharmacists and pharmacists-in-training and their knowledge and experiences with substance use disorder, both in their patients and amongst themselves, as well as some innovative practices. As much of our readership is practitioners in mental health, one must acknowledge the correlation between substance dependence and mental illness. According to a 2011 survey conducted
Tramadol, a synthetic, centrally acting analgesic with weak mu-opioid agonist activity, is often prescribed as an alternative to opioids due to its negligible abuse potential. Although the potential for the abuse of tramadol appeared low when the medication first became available, findings have demonstrated increased rates of abuse with extended time on the market. This case report details the addiction to tramadol of a 39-year-old female serving in the United States Army. At the height of her addiction, she was consuming an average of 1400mg tramadol daily. Eventually the patient entered into residential inpatient treatment for 28 days at our facility. During this time she was successfully titrated to buprenorphine 8mg/naloxone 2mg daily while maintaining abstinence. Patient care transitioned to the outpatient treatment center during which she maintained sobriety with the continued use of buprenorphine/naloxone. This case adds to previous reports of the increasing abuse of tramadol and the need for quality evidence on successful treatments for this escalating concern.
Opioid use disorder is a growing problem in the United States that can have devastating consequences on affected individuals. Buprenorphine is a partial mu-opioid agonist that can be used in the treatment of opioid dependence. In this article, the pharmacology of buprenorphine is discussed as is the dosing strategy. Formulations and product availability are mentioned and assessed. Several studies comparing the use of buprenorphine to methadone for opioid dependence are briefly reviewed.
Background: Approximately nineteen million individuals in the United States are diagnosed with a substance use disorder (SUD), including many veterans enrolled in the Veterans Health Administration (VHA). The prevalence of SUD within the veteran population has been steadily increasing, resulting in increased utilization of substance abuse services, such as buprenorphine programs for opioid dependence. As this population grows, there is an increased need for multidisciplinary services. Clinical psychiatric pharmacists do not have prescriptive authority for buprenorphine, but can play a vital role in outpatient buprenorphine programs.
Description of Innovative Service: The clinical psychiatric pharmacist is involved in many aspects of the outpatient buprenorphine program. There are over 100 patients enrolled in the buprenorphine program at the White River Junction Veterans Affairs Medical Center (WRJVAMC). The clinical pharmacist devotes approximately ten hours per week to the program, which includes dispensing the medication, monitoring lab values, patient counseling and random medication counts. A spreadsheet is maintained and updated weekly to monitor doses, refill dates and urine toxicology results. The clinical pharmacist is also involved in the dispensing process in the outpatient pharmacy; this allows for open communication between the clinical pharmacist and patient.
Impact on Patient Care: The clinical psychiatric pharmacist has been involved in the outpatient buprenorphine program at the WRJVAMC for approximately two years. Prior to this, the program included less than 100 patients, pharmacy wait times were over sixty minutes and early refills were frequent. Since clinical pharmacy involvement, the pharmacy wait time is approximately 30 minutes or less and early refills are infrequent. Patient satisfaction has also significantly improved. The clinical pharmacist has helped open the lines of communication between the patient, the pharmacy and the prescriber.
Conclusion: Substance use disorder programs, such as buprenorphine programs, can benefit from clinical pharmacy involvement. Even with limited prescriptive authority, clinical psychiatric pharmacists can play an important and active role in outpatient buprenorphine programs.
The Center for Drug and Alcohol Programs (CDAP) at the Medical University of South Carolina (MUSC) focuses on research and clinical services for substance use disorders. CDAP is comprised of both inpatient and outpatient services. Outpatient services include an intensive program with daily group meetings and an individualized treatment program where patients are able to take part in one-on-one counseling. Approximately 1200 outpatients are seen in the CDAP clinics annually, 300 of which are in the intensive outpatient program. The patients seen in CDAP have a range of substance use disorders which include alcohol and opioid dependence, among others. Given
Background: Tobacco use is the most prevalent preventable cause of death in the United States, accounting for approximately 20% of all deaths each year. Despite available treatment options, many smokers still experience multiple failed quit attempts indicating a need for development of novel therapies. When the electronic cigarette (e-cigarette) was introduced to the United States' market in 2007, patients began to discuss its possible use as the newest form of nicotine replacement therapy (NRT).
Methods: A PubMed search was performed for the following terms: “Electronic cigarettes, e-cigarettes, and smoking cessation”. A manual search of references from articles found was performed to identify additional relevant articles.
Results: Most evidence surrounding use of e-cigarettes for smoking cessation is found in self-reports and user surveys. One study looking at short-term effects of e-cigarettes on desire to smoke found a decreased desire in subjects inhaling from both nicotine-containing and placebo e-cigarettes. Three studies from Italy looked at natural reduction of cigarette use when subjects were allowed to freely use e-cigarettes. All three studies showed a natural reduction indicating potential efficacy for e-cigarette use in smoking cessation. A recently published randomized controlled trial was unable to prove superiority of e-cigarettes over transdermal nicotine patches for smoking cessation.
Conclusions: A few studies have explored the possibility of replacing tobacco cigarettes with e-cigarettes to facilitate a natural reduction in use and have shown minimal positive results in a population not intending to quit. A recent randomized controlled trial comparing e-cigarettes with nicotine patches for smoking cessation was unable to prove superiority. Until these products are regulated and efficacy can be shown with well-designed studies, e-cigarettes are not a viable treatment for use in smoking cessation or as nicotine replacement therapy.
The term “harm reduction” conjures up many reactions, including many political and emotional responses. What exactly is harm reduction? What is it not? Are pharmacists involved in harm reduction practices? Do they embrace the principles of harm reduction? What should the role of the pharmacist be? How far along the continuum are you as a pharmacist willing to go? Harm reduction is a concept that can be applied to areas other than drug use, but for the purposes of this discussion it “refers to policies, programs and practices that aim to reduce the negative health, social and economic consequences that
Background: As pharmacists are increasingly involved in delivering services to chemically dependent populations, it is prudent to explore the perceptions community pharmacists have regarding such patients. Methods: A random sample of one thousand pharmacists were sent a questionnaire Results: Twenty-nine percent of responders report no formal education about chemical dependence in pharmacy school. Sixty-four percent of the sample believed that the pharmacist plays a vital role in the treatment of addiction; however slightly more than one third of the respondents admitted to being annoyed rather than sympathetic toward addicted patients. Conclusions: This survey highlights the need for more extensive education in pharmacy school regarding chemical dependence.
“Bath Salts” or synthetic cathinone derivatives have made waves during the past several years in the designer drug market as a new trend in drugs of abuse. Natural cathinones are psychoactive chemicals that have been historically consumed by chewing Khat, or Catha edulis, leaves and shoots in regions of Africa and the Arabian Peninsula. Traditionally, Khat has been utilized to increase alertness and enhance euphoria as CNS stimulants commonly used by religious leaders and militant factions.12 The pharmacologic effects of synthetic cathinones have been noted to be similar to cocaine, amphetamines, and 3,4-methylenedioxy-N-methylamphetamine (MDMA/ecstasy)INTRODUCTION
Substance abuse is often publicized but regrettably is viewed with a negative point of view. Moreover, the consequences to the pharmacy profession can be disastrous when pharmacists themselves become victims of substance abuse. In addition to an affected pharmacist performing poorly, countless patients could have their safety jeopardized resulting in potential patient harm. I received my BS-Pharmacy degree in 1997. I had a great start to my career. I was selected as a participant in a Leadership Pharmacy conference held by my state pharmacist association in 2002. In 2004, my career hit bottom as a result of theInsert 1
Alcohol dependence affects a small proportion of the population but contributes disproportionately to crime and other societal burdens.1 Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) suggest that approximately 2% of alcohol users transition to dependence after their first year of use. This number increases to approximately 11% after a decade of use.1 There remains, however, a paucity of evidence regarding alcohol use and dependence in healthcare students, particularly those entrusted with oversight of the medication use system. One important goal of the present study is to estimate the probability of student
The following is a brief background and account of the psychostimulant ‘designer drug’ and curious methylphenidate-ethanol transesterification metabolite, ethylphenidate (EPH; Fig 1). That is ethylphenidate with an ‘E’, not it's well known homolog, methylphenidate (MPH; Ritalin®, Concerta®, others) – the first-line agent for the treatment of attention-deficit/hyperactivity disorder (ADHD). Note that the only structural difference resides in the ester where EPH has an ethyl group rather than the methyl group in MPH. dl-EPH is described chemically as
Background: The Student Pharmacist Chemical Health Scale (SPCHS) is a tool designed to evaluate substance use behaviors and risk factors for substance abuse among student pharmacists. Methods: It was administered to a sample of student pharmacists at the University of Georgia (UGA) as a preliminary component of a longitudinal study evaluating student pharmacists nationwide. Results: This final scale was found to have a high degree of internal consistency and showed appropriate content and face validity for the domains tested. Conclusions: Future analyses will center on further validating the SPCHS in known groups of pharmacists with substance use disorders.
Drugstore Cowboy takes place in the early 1970's, in the wake of the cultural revolution when recreational drug use was more widely tolerated. The film stars Matt Dillon as a young man named Bobby who becomes addicted to opioids, including hydromorphone, at a young age. The movie features him traveling the country with his wife and another couple, stealing prescription drugs from local pharmacies and hospitals in search of the next high. This movie depicts many of the hallmarks of substance use disorder, including persistent opioid abuse despite social and interpersonal problems stemming from theSTUDENT AND FACULTY PERSPECTIVE
As we enter the last month of this year, it is common practice to reflect on the past year and plan for the next. The vow to exercise, eat better and read more are common personal resolutions we pledge to meet in the New Year. As you sketch out your 2014 resolutions, a reminder to set your professional goals as well and utilize CPNP to help you reach them. Resolve to get involved in professional activities such as: Volunteering for activities such as a CPNP committee, editorial board or author opportunities. Attending the 2014 Annual
The College of Psychiatric and Neurologic Pharmacists (CPNP) membership has elected three officers to serve on the 2014–2016 Board of Directors. Assuming their offices effective July 1, 2014, will be President-Elect Drs. Raymond Love, Secretary Jennifer Zacher, and Member at Large Jonathan Lacro. Dr. Love is currently serving the first year of a two-year term as Member at Large to the Board. With his selection as President-Elect, a vacancy on the board will occur on July 1, 2014. CPNP bylaws require that President-Elect Steve Burghart name an individual to complete this 1-year term. Dr.MEET YOUR NEWLY ELECTED BOARD MEMBERS