Community Pharmacists and Substance Use Disorders: Attitudes, Knowledge and Practices

Background: Substance use disorder (SUD) is a serious health concern affecting a large proportion of the US population. Community pharmacists are well-positioned to prevent, screen, and provide appropriate treatment for SUD. Stigma towards these patients and SUD results in reduced quality of care as well as poor treatment outcomes. It is imperative that pharmacists have the appropriate knowledge of and attitude towards prevention, harm reduction and treatment to develop therapeutic relationships and improve their delivery of pharmacy services Objective: To assess knowledge, practices (with an emphasis upon screening), stigma and general attitudes of community pharmacists towards SUD and evaluate the relationship between these factors. Methods: A systematic literature review was conducted prior to beginning the study that identified gaps in the literature. Based on the results of the review, a questionnaire was developed assessing the following: demographic information, practice and educational characteristics, knowledge about SUD medications, practices of pharmacists (especially screening), stigma towards SUD patients and attitude towards harm reduction strategies and treatment for SUD and a general open-ended question. Online survey methodology was used to distribute the questionnaire on Qualtrics© (Provo, Utah) software among a sample of community pharmacists (n =960) from the Duquesne University alumni network and Giant Eagle Pharmacy chain via an email link. Data was collected over a period of four months. The data was analyzed using SPSS Statistics 24 (Armonk, NY). Descriptive data, mean differences and correlations were performed and regression models were designed to predict knowledge, practice, screening and stigma. Content analysis with axial analysis was carried out for the protocols obtained from the open-ended question. Results: The response rate was 134 (13.9%) and on average pharmacists were 38.3 years old, mostly female and Caucasian, and the majority had PharmD (vs B.S.) degrees. Respondents primarily reported working in suburban areas for 15 years and about 37 hours/week on average in pharmacies that filled about 2000 prescriptions/week. Just over half of the sample reported receiving previous SUD specific education and continuous education (CE) in SUD and/or naloxone. The majority reported not having any personal experience with SUD. On average, pharmacists answered 69% of the knowledge questions correctly, performed about half of the possible clinical services, reported rarely performing MTM or clinical services, regarded screening as an important practice, had stigmatizing attitudes towards SUD patients and slightly negative attitudes towards harm reduction strategies and SUD treatment. Having lower stigma was significantly related to performing MTM and clinical services. Higher screening scores was positively correlated to higher practice but lower stigma scores. A combination of predictors was found to be significant for knowledge, practice, screening and stigma. Number of years worked and CE in naloxone were significant predictors of knowledge. Low stigma significantly predicted a higher likelihood of performing clinical services for SUD. Stigma and number of years worked also predicted screening as an important practice. Screening and never/rarely performing MTM services predicted high stigma among pharmacists. Scale of the opioid epidemic, overprescribing and prescriber accountability were some of the most frequently occurring categories in the protocols. Conclusion: The study was a comprehensive survey of knowledge, attitudes and practices of community pharmacists in SUD. Their knowledge of medications, current practices, their perception of the relevance of screening, assessment of stigma and their general attitudes toward SUD were explored. Significant relationships and associations were found among these factors and descriptive data. These results could help improve research in the area, increase the role of the pharmacist in SUD, help provide better health-care, and assist in improving treatment outcomes for patients