According to the Centers for Disease Control, more than 200,000 people died in the United States from overdoses related to prescription opioids between 1999 and 2016. And, overdose deaths involving prescription opioids were five times higher in 2016 than in 1999.

Professor Matthew Perri III, clinical and administrative pharmacy program director at the University of Georgia, is spearheading a training initiative that prepares pharmacists to recognize patients with opioid abuse problems or the potential for problems. The program is called SBIRT, which stands for Screening, Brief Intervention, Referral and Treatment, and it is designed to identify patients who might have problems with alcohol or other drugs, including opioids, so that appropriate interventions can be proposed.

UGA assistant professor Amanda Abraham in the School of Public and International Affairs is the project investigator for the SBIRT grant, and others at UGA are involved as well, including the School of Social Work and department of psychology.

Describe the training initiative you are working on with pharmacists.

We use a variety of screening tools and communication techniques to gather information from patients to help us decide what that individual needs. First, we categorize their alcohol use as low, medium or high risk. For illicit drugs, any use is considered high risk. Then, once we’ve identified problems or potential for problems—such as someone who reports moderate-risk alcohol use—we use behavioral interventions and effective communication strategies to educate the patient and encourage them to engage in behavior change.

 What are the warning signs a pharmacist learns to detect?

We use several validated screening tools like the AUDIT (alcohol use disorders identification test) and the DAST (drug abuse screening tool) along with single item measures such as this question: “In the last year, have you used a prescription drug for any non-medical purpose?”  We also pay attention to clues in the patient’s presentation that suggest drug or alcohol abuse potential. Clues include things like requesting early refills on pain medications, use of multiple doctors who are each writing prescriptions for pain meds, non-adherence, resistance to medication changes, requests for increased doses, etc.  Patients who are not at risk don’t ask for early refills, or dose escalations. We also look for other risk factors like tobacco dependence, history of alcohol, cannabis or cocaine use, a family history of substance abuse, depression and anxiety, or legal problems.

What is the scope of the training initiative?

We are training pharmacy students in the SBIRT program and associated skills, and we are currently on our third class that will graduate with these skills. We’ve also begun to train practicing pharmacists, and have developed several continuing education programs related to SBIRT for them, so that when our students hit the workplace, there will already be practicing pharmacists who have some SBIRT skills.