Objective. To assess the impact of a pilot advanced pharmacy practice experience (APPE) on fourth year (P4) Doctor of Pharmacy (PharmD) students’ knowledge and confidence related to substance use disorders (SUD), harm reduction, and co-occurring psychiatric conditions. Methods. Beginning in 2020, a 62-item assessment was developed and administered to P4 students at the beginning and end of the six-week APPE. The assessment tested knowledge in 10 content areas related to SUD, harm reduction, and co-occurring disorders. Students also ranked their confidence providing care related to each content area. The post-assessment included a free text item to provide feedback on the APPE experience. Descriptive statistics and paired t-tests were used to analyze the data. Results. Complete pre- and post-assessments were obtained from all participating students (n=7). The mean cumulative knowledge score increased from 55.2% to 81.5% and the mean cumulative confidence score improved from 34.2% to 81.8%. Free text responses garnered positive feedback from students stating the APPE allowed them to immerse themselves in all stages of the recovery process, increase confidence in presentation skills with patients, and solidified their passion for addiction medicine. Conclusion. A novel APPE in addiction medicine addressed a current gap in pharmacy education, earned positive evaluations from student pharmacists, increased student knowledge and confidence related to SUD, harm reduction, and co-occurring disorders, and supported the development of new interprofessional collaborations. United States colleges of pharmacy that do not yet offer APPEs in this clinical domain should consider this model.

Introduction: Maintaining abstinence through the opioid withdrawal period is a substantial barrier to treatment for patients with opioid use disorder. The alpha-2 agonist lofexidine has demonstrated efficacy and safety in clinical trials, but pragmatic studies describing its use in clinical practice are lacking. This case series describes the use of lofexidine for opioid withdrawal symptoms in an inpatient addiction treatment facility. Methods: Seventeen patients receiving at least 1 dose of lofexidine during inpatient treatment for opioid withdrawal were included in this study. A retrospective chart review was conducted for clinical, subjective, and objective data. Adverse events, total daily dose, clinical opioid withdrawal scale (COWS) scores, vital signs, and reasons for early discontinuation of lofexidine are reported. Results: Patients treated with lofexidine experienced mild withdrawal symptoms throughout treatment. Most patients (65%) experienced a decrease in their average daily COWS scores from intake to discharge. Two patients (12%) left treatment against medical advice, and 5 patients (29%) discontinued treatment prior to day 7 due to resolution of symptoms. Average daily blood pressure readings remained stable, and daily average heart rate decreased over time. Discussion: Lofexidine can be successfully incorporated into a conventional withdrawal management protocol. The cost of lofexidine and its recent introduction to the market remain barriers to accessibility in the United States. Studies evaluating patient-reported outcomes as well as direct comparisons with other alpha-2 agonists are needed to inform optimal clinical use of lofexidine.