APhA Institute has new format, usual memorable moments

GET CLINICAL

Valerie Amedeo, Western New England University (WNE) College of Pharmacy and Health Sciences; and Morgan Bizzell, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill are final-year PharmD candidates; Trisha Patel, University of the Sciences Philadelphia College of Pharmacy, is a 2021 PharmD graduate; and Nathan Croner is a third-year PharmD candidate at the WNE College of Pharmacy and Health Sciences.

Based on the guidance from The University of Utah and public health officials, as well as travel bans implemented by different institutions, the 2021 APhA Institute on Substance Use Disorders was conducted virtually this year. Despite this change in format, the experience was as informative and memorable as ever.

The four of us served as small group leaders, and we facilitated the discussion, reflection, and connection during the 4 nights of programming (June 1 to 4). Here is a recap of the noteworthy events.

Nathan (Night 1)

The Institute began in traditional fashion, with an introduction to 12-Step recovery led by co-leader Charlie Broussard, BSPharm. He noted we would learn about aspects of substance use disorders (SUDs) from the neurobiology of the addicted brain and the maladaptive behaviors of those suffering from SUDs to the codependent effects addiction has on the family unit, and the ways we can equip ourselves to work with people with substance use disorders (PWID) seeking out our help and guidance.

The session by Merrill Norton, PharmD, DPh, Certified Master Addiction Counselor, “The Self in Shame: Healing the Wounds of Substance Use Disorders,” closed out the first day of the conference by outlining the powerful thoughts and emotions that lead to the shame and guilt experienced by individuals with SUDs. Feelings of inadequacy become enmeshed with identity as PWID believe they are defective, unworthy, and unlovable. This reinforces a cycle of shame and anxiety that continues to destroy lives until the person is able to ask for help.

There were many poignant moments in this presentation, but the most profound for me was hearing that our main purpose as clinicians is to make sure the person struggling with SUD lives until tomorrow. Nothing is more important than keeping the individual alive. When we place the focus on this basic human need for survival rather than making moral judgments or relying on assumptions about PWIDs, we open ourselves to the possibility of becoming true advocates for recovery.

Valerie (Night 2)

The second night of the Institute began with an important session focused on SUDs and its impact throughout the COVID-19 pandemic. Led by Jeffrey D. Gold, PharmD, BCPP, and Beeta Homaifar, PhD, the discussion involved the effects of the pandemic on a person’s mental health, including those who are health care professionals. It was eye-opening to hear about the increase in abuse of substances alongside experiencing loss of their jobs, friends, and family. A key takeaway from this presentation was the need to strive to take care of yourself, and those around you, especially in times of hardship. When our needs are not met, our mental health, physical health, and ability to function can deteriorate, leaving us vulnerable.

Following this impactful discussion, Leah Sera, PharmD, BCPS, presented a newer challenge for pharmacists: cannabis. With the progression of legalized cannabis use in the United States, it is more important for pharmacists to have up-to-date knowledge to provide better care as medication experts. Dr. Sera discussed the pharmacology and evidence behind the limited information regarding medical marijuana and its role in care for various diseases, such as cardiovascular disease or schizophrenia. However, this is just the beginning of the conversation on medical marijuana use in patients, as there is much more currently being discovered.

Morgan (Night 3)

This was the night when the Institute shifted from pathophysiology and the effects of the pandemic to focusing on the impact of SUDs on patients and their loved ones. The reality of SUDs definitely hit home for attendees. There were two presentations, “Case Study of a Pharmacist” and “Family Matters: Understanding and Addressing the Impact of Addiction on Family,” followed by a small group meeting.

During the case study presentation, Institute attendees heard from a pharmacist in recovery, as well as his wife, and listened to their experiences. This session showed that SUDs can affect anyone, and it gave firsthand insight into how it impacts those involved.

 Jerry Moe, National Director of the Hazelden Betty Ford Children’s Program and best-selling author, closed out the presentation portion of the evening with a fan favorite—one that past attendees always remember. He spoke on the impact of SUDs on the family, with an emphasis on children. He shared pictures that the children had drawn and their stories, as well as his own personal experiences. One of the biggest takeaways was that we must learn how to let go of the disease and accept the person, instead of the other way around.

Trisha (Night 4)

The most impactful session for me this year was by Joel Onafowakan, MD, “Addressing Racial Disparities in Substance Use Disorders,” during the last night of the meeting. While patients with SUDs are often marginalized and face barriers to receiving treatment, race contributes to additional disparities. African American, Hispanic, and low-income patients are less likely to receive buprenorphine, which is less stigmatizing and easier to access compared to methadone. Factors that may contribute include providers with implicit biases, patients with fears of potential consequences to receiving treatment, and lack of access to an X-waivered provider. As a result, these groups are less likely to receive treatment for SUDs. Barriers to treatment worsen initiation and retention in treatment, both of which lead to undesirable outcomes. In addition, there are data that African American patients are often undertreated for pain compared to Caucasian patients with similar diagnoses.

I could feel Onafowakan’s passion for addressing these issues, even in a virtual conference format. As pharmacists, it is important to ensure each patient receives the most optimal, evidence-based treatment for SUDs. Knowing that disparities exist is just the first step; it is important to emphasize educating health care team members, communities, and patients. Being on the health care team places pharmacists in a prime position to intervene and alleviate barriers where they may exist.

The Institute is important for addressing relevant topics relating to SUD and prepares and provides resources to pharmacists and students so they can serve as advocates for patients in their respective communities.