(1334) Development and Initial Testing of a Pilot Pharmacy-based Digital Opioid Safety Intervention

Objectives: To identify pharmacist and patient needs regarding specific content and formatting for a digital opioid safety tool as foundation for development and pilot testing of a prototype pharmacy-based digital opioid safety intervention.

Background:
Community pharmacists are uniquely positioned to offer opioid safety interventions due to their high accessibility and medication expertise. Our initial research identified SEVERAL pharmacist-reported implementation barriers WITH CURRENT OPIOID MEDICATION SAFETY INITIATIVES, including mixed perceptions about the need for change in pharmacy practice and perceived inability to change setting characteristics or workflows significantly to accommodate opioid safety interventions. Patient-identified needs regarding prevention interventions included CLEAR AND ACCESSIBLE EDUCATION ABOUT SAFE OPIOID MEDICATION USE, preferences for the privacy and convenience of digital rather than in-person formats, use of non-stigmatizing language, and improved communication with healthcare teams. CURRENT OPIOID MEDICATION SAFETY INTERVENTIONS ARE NOT PATIENT-CENTERED AND LACK IMPLEMENTATION FOCUS LEADING TO INTERVENTIONS THAT ARE NOT SUSTAINED IN PRACTICE. A digital opioid safety tool can address patient needs for a private and convenient format to obtain knowledge without increasing pharmacist workloads, THEREBY INCREASING INTERVENTION ACCEPTABILITY AND FEASIBILITY. Optimal opioid-related patient outcomes and improved pharmacist roles in opioid-related care require the development of patient-centered digital opioid safety interventions that promote pharmacist roles in opioid misuse prevention.

Methods: Using the Consolidated Framework for Implementation Research and an exploratory sequential mixed methods study design, we are conducting semi-structured qualitative interviews (n = 30) with patients using opioid prescriptions for chronic/acute pain, pharmacists, and individuals with a history of prescription opioid misuse. INTERVIEW PROMPTS WERE DEVELOPED TO ADDRESS PATIENT AND PHARMACIST NEEDS REGARDING CONTENT (TOPICS TO BE COVERED, MISPERCEPTIONS TO BE ADDRESSED), FORMAT (APP/WEBSITE), AND IMPLEMENTATION BARRIERS AND FACILITATORS (INDIVIDUAL/INTERPERSONAL/SETTING LEVELS). A deductive and inductive content analysis followed by a narrative analysis approach are being used to analyze interview transcripts. Using the building approach to mixed methods integration, WE USED the qualitative data TO inform design of the digital opioid safety prototype including content, tailoring language, and formatting of the prototype based on stakeholder needs. We will also collect preliminary EFFICACY DATA (FOR INCREASING OPIOID SAFETY KNOWLEDGE AND DECREASING MISPERCEPTIONS/STIGMA), AS WELL AS usability, feasibility, and acceptability data on this prototype from representative end-user patients and pharmacists through quantitative surveys (n =50).

Results: Our interviews identified SIGNIFICANT gaps in patient knowledge regarding opioid safety, even when taking opioid medications correctly. Patient beliefs such as ‘naloxone is only for people with opioid use disorders (OUD)’, ‘there are no safety concerns if I take opioids as prescribed’, ‘OUD occur from recreational use only’, and ‘it was okay to keep unused opioid medications at home’ were common. In addition, most patients received their information from the news and social media outlets rather than healthcare professionals or verified sources, which was associated with mistrust of providers, disbelief of opioid risks, and negative attitudes towards safety interventions such as naloxone and opioid tapering. PATIENTS PREFERRED CONTENT ON SAFE OPIOID MEDICATION USE AS AN APP THEY COULD ACCESS AT THEIR CONVENIENCE. Pharmacists highlighted the need for de-stigmatizing naloxone and increasing rates of naloxone dispensing. Participants emphasized the need for patient-centered language, audio and video content, and balanced messaging between preventing opioid harms and effective pain management. Using this data, we have developed the digital prototype OF THE OPIOID MEDICATION SAFETY APP THAT COVERS PAIN MANAGEMENT, SAFE OPIOID USE, MEDICATION STOARGE AND DISPOSAL, AND NALOXONE USE.

Conclusions: FUTURE RESEARCH WILL INCLUDE REFINEMENT OF THE PROTOTYPE BASED ON END-USER FEEDBACK TO INCLUDE AN OPIOID MISUSE SCREENING COMPONENT. RESULTS OF PILOT WILL INFORM DEVELOPMENT OF A NOVEL PHARMACY-BASED DIGITAL SCREENING AND BRIEF INTERVENTION FOR OPIOID MISUSE AND A LARGER EFFECTIVENESS RESEARCH STUDY.