Resolving Uncertain Red Flags: SBIRT as a Tool for Pharmacists to Help Identify Risk and Prompt Dispensing naloxone

Overview

A common issue that pharmacists encounter daily in the community setting is “red flags” associated with a controlled substance prescription and determining whether to fill that prescription or not. A red flag is a circumstance arising during the presentation of a prescription which creates a reasonable suspicion that the prescription is not, on its face, legitimate. Pharmacists have few tools in their toolkit to resolve these red flags, including calling the prescriber, talking with the patient, and checking the state’s controlled substance monitoring database. We propose adding the SBIRT tool, which is an acronym for Screening, Brief Intervention, and Referral to Treatment, to that list. SBIRT is a comprehensive, validated tool that has experienced little uptake in the pharmacy profession. Dispensing naloxone is a step that community pharmacists can take in Tennessee to mitigate the risk of overdose. Resolving uncertain red flags present would likely qualify a patient to also receive naloxone. Thus, it would be a natural opportunity to use the SBIRT tool to prompt the discussion about naloxone and dispense it. This study trains pharmacists and student pharmacists on a tool they can implement into their practice, measures their willingness to use that tool, and could identify another opportunity to dispense naloxone. In sum, this intervention can support pharmacists practicing at the top of their license, both by not filling invalid prescriptions, connecting patients to care who may need it, and providing naloxone, when appropriate. Specific Aims: 1. To train pharmacists and student pharmacists on Screening, Brief Intervention, and Referral to Treatment (SBIRT) 2. To measure pharmacists and student pharmacists’ willingness to use SBIRT, specifically in screening patients for unhealthy drug use. 3. To measure pharmacists’ willingness to dispense naloxone, specifically once a patient is identified at risk based on the implementation of SBIRT. 4. To ascertain barriers and facilitators in using SBIRT as a tool to resolve “red flags” in the community pharmacy setting. Recruitment We will recruit 50 pharmacists from across the state of Tennessee. We will first identify the regions that the ROPS are located in across the state. We will identify the zip codes within those regions with the highest rates of opioid overdose deaths. We will locate all pharmacies in these zip codes and recruit 50 pharmacists to participate. We will recruit using a targeted mailer as well as cold calling. To be recruited, pharmacists must have an active Tennessee license, currently practice in a community pharmacy in Tennessee, and have a collaborative practice agreement to dispense naloxone. We will compensate pharmacists $75 for their time in completing the 1-hour training. We will also partner with a student pharmacist organization to offer the training during the lunch hour in Spring 2021. SBIRT Training (Aim #1) We will create a 4-part series that is a total of 1 hour in length to train pharmacists and student pharmacists how to use SBIRT. This will employ a microlearning approach to break down the SBIRT model into manageable parts, with each part 15 minutes in length. Part 1 will be dedicated to screening, teaching pharmacists how to use the National Institute on drug abuse (NIDA) Quick Screen tool. Part 2 will be dedicated to the brief intervention component, reviewing motivational interviewing. Part 3 will be dedicated to referral to treatment where we review resources available to pharmacists to provide (i.e., naloxone) and help them connect patients to care. The 5 A’s (ask, assess, assist, advice, and arrange) will also be embedded throughout. Finally, Part 4 will be dedicated to tips for the pharmacists to document that they conducted SBIRT, how to use SBIRT in combination with other tools to resolve red flags and more. We anticipate this SBIRT mini-series will be accredited for 1 hour of live continuing education credits.