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At time of writing, Research and Academic Fellow now, Clinical Coordinator/Assistant Professor Mylan School of Pharmacy Duquesne University 322 Bayer Learning Center 600 Forbes Avenue Pittsburgh, Pennsylvania 15282 fax 412/396-5130 tomko170{at}duq.edu
Professor Mylan School of Pharmacy Duquesne University
Published Online, December 19, 2006. www.theannals.com, DOI 10.1345/aph.1H108
We report the results of an exploratory quasi-experimental study that examined the impact of differing pharmacist–patient counseling techniques on abstinence and treatment retention in opioid-dependent subjects in urban and rural buprenorphine provider physician settings.
Methods. The study was approved by the Duquesne University Institutional Review Board/Human Subjects Research Committee after full board review. Forty-two subjects were enrolled. Subjects enrolled in the control cohort (n = 20) were counseled regarding their medication therapy at the first visit. Experimental cohort subjects (n = 22) were counseled regarding their medication therapy with additional dialogue encouraging participation in nonpharmacologic treatment of chemical dependence. The dialogue was guided with the use of an algorithm that provided the pharmacist with prompting lines of questions. This questioning reinforced the importance of involvement in lifestyle change and nonpharmacologic treatment, such as support group attendance and drug rehabilitation participation. Repeated interactions with each experimental subject at subsequent visits encouraged the development of a therapeutic alliance.
Results. Demographics between groups and overall were similar to those of previously reported studies and clinical trials.1-3 Four experimental and 5 control subjects completing the 90 day enrollment remained abstinent and in treatment. Relapse rates of experimental and control cohorts were 81.8% and 75.0%, respectively. No significance was found in pharmacist influence upon relapse to opioid abuse. The rate of buprenorphine treatment rechallenge among relapsing subjects was higher in the experimental group (10; 45.5%) than in the control group (4; 20.0%). Including subjects who completed the enrollment period abstinent, as well as those who returned and completed treatment following one relapse, overall abstinence rates yielded 13 experimental subjects (59.1%) versus 8 control subjects (40.0%). Despite the lack of statistical significance, the trend toward experimental subject willingness to rechallenge treatment following relapse and remain abstinent may be due to therapeutic alliance formation and reinforcement of adjunctive nonpharmacologic treatment as emphasized in the algorithm. Both the development of a therapeutic alliance and reinforcement of nonpharmacologic adjunctive therapy have been found to be important influences on abstinence in other studies of addiction and as described in a personal communication (Daniel Alford MD MPH, Assistant Professor, Boston University School of Medicine, Boston Medical Center, and Colleen LaBelle RN, Nurse Program Manager, Office Based Opioid Treatment Program, Boston Medical Center, 2004 Sept 14).4,5
The trend toward positive abstinence and treatment retention rates is leading us to further study this counseling technique in a larger, community pharmacy population. With the development of medications that are dispensed in community pharmacies to assist individuals with addiction disorders, pharmacist reinforcement may be an effective tool in an overall abstinence program. In addition, a survey is being developed that will assess pharmacist attitudes, beliefs, and knowledge deficits in the area of opioid dependence. Results of this survey will be used to guide curricular decisions and aid in the development of pharmacist practitioner educational programs.
Footnotes
We thank Robert A Woolhandler MD and John J Vargo DO for their help and participation in this study.
References
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