Effective intervention strategies for increasing dispensing of intranasal naloxone by pharmacists should focus on pharmacists' concerns, include education to multiple audiences, and address provider-level, system-level, and society-level barriers.

This is a case report of metformin-induced hepatotoxicity. As the prevalence of type 2 diabetes and subsequent metabolic effects increases in the US, metformin use will likewise increase. As potential for increased idiosyncratic hepatotoxicity associated with metformin use is likely to occur, clinicians should be vigilant.

What is already known on this topic? It is estimated that 13 million people in the United States have latent tuberculosis infection (LTBI). This large number of potential LTBI cases poses a challenge for successful tuberculosis control and elimination. What is added by this report? We examined a novel, collaborative care model using community pharmacies as additional access points for LTBI treatment for patients using combination weekly therapy with isoniazid and rifapentine and directly observed therapy for 12 weeks. What are the implications for public health practice? High completion rates and safe administration of LTBI treatment can be achieved in the community pharmacy setting.

Background Given that opioid misuse/abuse and opioid overdose have reached epidemic proportions in the U.S., expansion of naloxone access programs are desperately needed. The objective of this study was to describe emerging trends in Naloxone Rescue Kit (NRK) prescription patterns by pharmacists in New Mexico as an example of a unique healthcare delivery system. Methods The study presents cross-sectional analysis of the data on NRK prescriptions by pharmacists who received Naloxone Pharmacist Prescriptive Authority Certification since 2013. Data were obtained from the Prevention of Opioid Overdose by NM Pharmacists (POINt-Rx) Registry, maintained by the University of New Mexico and the New Mexico Pharmacists Association. Results Since 2013, 133 NRKs prescribed by pharmacists have been reported to the POINt-Rx Registry. The mean age of the patients was 41.5±12.0 years (range: 19–67 years) and there were 60.2% female participants. Only 11.3% of the prescriptions were from pharmacists practicing in rural/mixed urban-rural areas. The majority of NRKs (89.5%) were first-time prescriptions. The most common reason for a NRK prescription was patient request (56.4%), followed by a pharmacist’s prescription of NRK due to high-dose of prescription opioids (28.6%) and history of opioid misuse/abuse (15.0%). In addition to opioids, other frequently reported substances included alcohol (9.2%) and benzodiazepines (10.8%). More than a third of patients (38.5%) reported polysubstance use in the previous 72 hours. Conclusions These results indicate that patients at-risk of opioid overdose might feel comfortable soliciting NRKs from a pharmacist. Participation of pharmacists in rural areas in the naloxone prescriptive authority highlight the opportunity for this novel healthcare delivery model in underserved areas; however, the program is clearly underutilized in these areas. Such a model can provide expanded patient access in community practices, while systematic efforts for uptake of the program by policy makers, communities, and pharmacists continue to be needed nationwide.