Background and Aims Patients with opioid use disorder (OUD) must be able to obtain prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. Telephone audits have identified concerning gaps in availability of NNS within US pharmacies, but the availability of BUP/NX has not been rigorously evaluated. This study estimated the availability of BUP/NX and NNS in the US state of Texas and compared availability by pharmacy type and metropolitan status. Design A cross‐sectional telephone audit with a secret shopper approach conducted from 18 May 2020 to 7 June 2020. Setting and Participants A random sample of 800 of 5078 (16%) community pharmacies licensed with the Texas State Board of Pharmacy. Measurements Primary outcomes included availability of a 1‐week supply of generic BUP/NX 8/2 mg films and a single unit of NNS 4 mg, overall and by pharmacy type. Secondary outcomes included willingness and estimated time‐frame to order BUP/NX if unavailable. Findings Data from 704 pharmacies (471 chain, 233 independent) were included for analyses. Of these, 34.1% of pharmacies (45.0% of chains versus 12.0% of independents, P < 0.0001) were willing and able to dispense a 1‐week supply of generic BUP/NX and a single unit of NNS. BUP/NX alone was available in 42.2% of pharmacies (52.4% of chains versus 21.5% of independents, P < 0.0001). NNS alone was available in 60.1% of pharmacies (77.9% of chains versus 24.0% of independents, P < 0.0001). Of the 397 pharmacies with generic BUP/NX unavailable, 62.2% of pharmacies (73.9% of chains versus 48.0% of independents, P < 0.0001) indicated willingness to order. Conclusions Most pharmacies in Texas do not appear to be willing and able to dispense prescribed buprenorphine/naloxone films and naloxone nasal spray to patients with opioid use disorder in a timely manner. Deficiencies in availability are markedly more pronounced in independent pharmacies compared with chain pharmacies.

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Introduction Maintaining abstinence through the opioid withdrawal period is a substantial barrier to treatment for patients with opioid use disorder. The alpha-2 agonist lofexidine has demonstrated efficacy and safety in clinical trials, but pragmatic studies describing its use in clinical practice are lacking. This case series describes the use of lofexidine for opioid withdrawal symptoms in an inpatient addiction treatment facility. Methods Seventeen patients receiving at least 1 dose of lofexidine during inpatient treatment for opioid withdrawal were included in this study. A retrospective chart review was conducted for clinical, subjective, and objective data. Adverse events, total daily dose, clinical opioid withdrawal scale (COWS) scores, vital signs, and reasons for early discontinuation of lofexidine are reported. Results Patients treated with lofexidine experienced mild withdrawal symptoms throughout treatment. Most patients (65%) experienced a decrease in their average daily COWS scores from intake to discharge. Two patients (12%) left treatment against medical advice, and 5 patients (29%) discontinued treatment prior to day 7 due to resolution of symptoms. Average daily blood pressure readings remained stable, and daily average heart rate decreased over time. Discussion Lofexidine can be successfully incorporated into a conventional withdrawal management protocol. The cost of lofexidine and its recent introduction to the market remain barriers to accessibility in the United States. Studies evaluating patient-reported outcomes as well as direct comparisons with other alpha-2 agonists are needed to inform optimal clinical use of lofexidine.

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Audit study methodologies have been utilized in pharmacy field research to obtain greater understanding of potential gaps in real‐world care and assess the accessibility of medications, services, and providers. Many audit studies utilize a secret‐shopper approach in which auditors follow specific assessment protocols and the subjects being audited are unaware of the audit taking place. The benefit of utilizing this approach, as compared to surveys or interviews, is that researchers are able to collect real‐world measures with minimized social desirability and recall biases. There are multiple audit study approaches investigators must consider. Additionally, successful audit studies often rely upon congruence of multiple auditors, and it is therefore essential to develop a study protocol that includes detailed guidance documents, data collection tools, and rigorous training and fidelity assessments. Audit methodologies must be conducted with meticulous auditor training and oversight, especially when investigators seek to audit a large sample and rely on auditors who may be participating on an unpaid volunteer basis. The purpose of this review is to provide an orientation to audit study methodologies and to describe best practices for conducting a successful audit study.

To assess the impact of a pilot advanced pharmacy practice experience (APPE) on fourth year (P4) Doctor of Pharmacy (PharmD) students' knowledge and confidence related to substance use disorders (SUD), harm reduction, and co-occurring psychiatric conditions. Methods. Beginning in 2020, a 62-item assessment was developed and administered to P4 students at the beginning and end of the six-week APPE. The assessment tested knowledge in 10 content areas related to SUD, harm reduction, and cooccurring disorders. Students also ranked their confidence providing care related to each content area. The postassessment included a free text item to provide feedback on the APPE experience. Descriptive statistics and paired t-tests were used to analyze the data. Results. Complete pre-and post-assessments were obtained from all participating students (n=7). The mean cumulative knowledge score increased from 55.2% to 81.5% and the mean cumulative confidence score improved from 34.2% to 81.8%. Free text responses garnered positive feedback from students stating the APPE allowed them to immerse themselves in all stages of the recovery process, increase confidence in presentation skills with patients, and solidified their passion for addiction medicine. Conclusion.A novel APPE in addiction medicine addressed a current gap in pharmacy education, earned positive evaluations from student pharmacists, increased student knowledge and confidence related to SUD, harm reduction, and co-occurring disorders, and supported the development of new interprofessional collaborations. United States colleges of pharmacy that do not yet offer APPEs in this clinical domain should consider this model.

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