Impact of Community Pharmacists on Reducing Opioid and Alcohol Co-Use: A Pilot Randomized Control Trial of a Medication Therapy Management Intervention

Background

Concurrent use of opioids and alcohol can result in respiratory depression, overdose, and death. Prior research has shown that 20%–30% of patients receiving opioid medications in community pharmacies engage in high-risk drinking. We adapted a medication therapy management-based intervention to address co-use and tested its feasibility, acceptability, and preliminary efficacy.

Design

This pilot study enrolled adult, English-speaking community pharmacy patients dispensed opioids who reported current drinking. Participants were randomized to standard medication counseling (SMC) or alcohol-targeted brief intervention-medication therapy management (ABI-MTM). ABI-MTM included two pharmacist-delivered sessions focused on reviewing medications/interactions, motivating participants to discontinue co-use, and providing a written action plan. We assessed enrollment, retention, intervention delivery, satisfaction, drinks per drinking day (DDD), and daily morphine milligram equivalent (MME) at baseline, 2, and 3 months. Outcomes were analyzed using descriptive statistics and generalized linear mixed modeling.

Results

We enrolled 44 patients (110% of target; 22 per group). No significant differences were found in age (mean = 55.8), sex (female = 65.9%), race (White = 95.5%), education (> high school = 95.5%), or health insurance status (insured = 95.5%). Consent and retention rates exceeded 90%, session delivery was ≥ 95%, and ABI-MTM satisfaction ranged from 79% to 89%. At 3 months, 59.1% of ABI-MTM participants versus 45.5% of SMC achieved ≥ 30% reduction in DDD and/or daily MME. Mixed models showed ABI-MTM recipients had 2.10 (95% confidence interval = 0.34–12.95) higher odds of achieving this reduction.

Conclusion

ABI-MTM demonstrated feasibility, acceptability, and preliminary efficacy. A fully powered trial is warranted to evaluate broader implementation.