Overdose prevention sites (OPS) are a harm reduction strategy that offer people who use drugs a variety of resources including but not limited to sterile supplies, linkage to healthcare resources, and intervention if an overdose occurs. OPS operate in over 120 countries and evidence has demonstrated they are an effective harm reduction strategy. Despite their success elsewhere, OPS remain federally illegal in the United States and thus there is limited research on their implementation and outcomes in the United States. This study aimed to identify Colorado healthcare providers’ knowledge and attitudes about OPS and determine if there is a correlation between healthcare providers with more knowledge about OPS having a more positive attitude about OPS. An electronic survey was distributed to healthcare providers in Colorado. Responses were collected in early 2022 and recorded on a 5-point Likert scale. Mean scores between 1 and 5 were calculated for each participant and analysis of variance methods were used to determine correlating demographic factors. A p value of ≤ 0.05 was used to determine statistical significance of all findings. This study included 698 participants. A Pearson correlation analysis revealed a strong positive relationship (r = 0.76, p < 0.0001) between provider knowledge and attitudes about OPS. Emergency medicine providers scored the highest in mean knowledge and attitude scores in comparison to all other specialties. Respondents affiliated with a harm reduction center exhibited the highest mean knowledge and attitude scores. Mean knowledge and attitude scores generally rose with respondents’ increasing encounters with people who inject drugs in a typical workday, except when reaching nine or more encounters, where a sharp decline occurred. Our study highlights the importance of education, exposure to harm reduction strategies, and inter-specialty collaboration in shaping healthcare providers’ knowledge and attitudes about OPS. The positive correlation between providers’ knowledge and attitudes about OPS suggests that educating healthcare providers on harm reduction strategies, specifically OPS, may lead to reduced stigmatization of OPS among healthcare professionals.

EDITORIAL article Front. Pharmacol., 02 March 2023Sec. Drugs Outcomes Research and Policies Volume 14 - 2023 | https://doi.org/10.3389/fphar.2023.1162703

Health equity will be achieved when every person is afforded the opportunity and resources to achieve optimum wellness. In order to achieve this goal, the medical community must acknowledge and address racial and ethnic health disparities (REHD) that permeate throughout healthcare institutions. There are many layers that contribute to this work. Understanding the history of racism, its influence on socioeconomic policies and medical practices, as well as acknowledging social determinants of health are critical steps in dismantling REHD. Within this historical context, providers can recognize how structural racism begets unconscious bias which inadvertently results in subpar care for underrepresented minority (URM) patients. Taken together, educators and leadership at medical institutions are in a position to teach REHD using a race-conscious method, in the context of addressing racism and mitigating the effects of implicit bias, so that future generations of healthcare providers can adequately comprehend the root cause of health disparities and truly advocate for their patients. Educators can develop confidence in having effective discussions on race by adopting a cultural humility model. To continue to develop socially-conscious healthcare providers, educational materials and curricula should incorporate topics involving diversity, equity, and inclusion. Health equity and reducing REHD also relies on diversifying student and leadership demographics. Academic institutions should create an environment that allows URM students, faculty, and staff to thrive. The information and ideas presented in this manual serve as a guide to modify the academic environment and curriculum so that we can move towards a more equitable healthcare system.

Integrating foundational and clinical science in medical and other professional healthcare degree programs has been well established as a means to enhance learning. However, implementation remains challenging, and a significant gap exists in guidance for non-professional degree programs to effectively accomplish both types of integration. Additionally, many modalities described in the literature are resource-intensive, scale poorly to larger groups, and are widely inaccessible. We present an online modality combining team-based learning and a simulation-based learning experience that fosters vertical and horizontal integration of physiology, pharmacology, and clinical science. The tools utilized include a vital sign simulator, video conferencing software, and a document-sharing platform. The activity demonstrated improved knowledge comparing pre- and posttests and evidence that the activity helped students integrate physiology, pharmacology, and clinical medicine. The novel structure is effective and accessible, uses open-source software and standard equipment available to most undergraduate and graduate faculty, and is adaptable to in-person, hybrid-remote, and fully remote delivery.

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This chapter summarizes some important side effects associated with anti-cancer drugs reported in 2021 and early 2022. DNA-crosslinking agent bendamustine can cause nephrogenic diabetes insipidus; cisplatin can cause thrombosis; cyclophosphamide can cause protein-loss enteritis. Hemorrhagic cystitis can be induced by cyclophosphamide, ifosfamide, and cisplatin, for which hyperbaric oxygen is effective to treat severe cases. Antimetabolite agent capecitabine can cause heart failure; 5-fluorouracil can cause lactic acidosis. Capecitabine can cause severe diarrhea and hand-foot syndrome in patients with partial dihydropyrimidine dehydrogenase (DPD) deficiency, necessitating a 50% reduction of capecitabine dose and DPD testing before initiating capecitabine or 5-fluorouracil. Alarmingly, a single dose of doxorubicin is enough to cause acute heart failure, and bevacizumab plus pertuzumab may cause irreversible heart failure. Bevacizumab can cause anaphylaxis, hypertension, and heart failure, while ramucirumab can cause renal failure and nephrotic syndrome. Notably, the first published cases of azathioprine-related cytomegalovirus-related nephrotic syndrome, overdose-vinblastine-induced Stevens–Johnson syndrome, bevacizumab-induced bilateral adrenal hematoma, imatinib-induced myasthenia gravis, and atezolizumab-induced liver fibrosis were summarized. Tyrosine kinase inhibitor capmatinib can cause interstitial lung disease; ibrutinib can cause atrial fibrillation; lorlatinib can cause hypertriglyceridemia and pancreatitis. Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitor abemaciclib can cause thrombosis. Proteasome inhibitor bortezomib can cause Stevens–Johnson syndrome. Immune checkpoint inhibitor atezolizumab can cause anaphylaxis and encephalitis; nivolumab can cause hypophysitis and type I diabetes. Lastly, different categories of anti-cancer drugs can cause pneumatosis intestinalis leading to bowel perforation and death in severe cases. These studies enhance the awareness of some rare or dangerous side effects of anti-cancer drugs.

This chapter summarizes the important side effects associated with positive inotropic drugs and antiarrhythmics reported in 2022 and early 2023. Digoxin toxicity can be precipitated by renal failure and furosemide. Although not all patients with digoxin toxicity are treated with digoxin immune Fab, digoxin immune Fab benefits patients with a shorter stay in the hospital and lower in-hospital mortality. Amiodarone can cause multiple organ dysfunction including liver and renal failure, hyperthyroidism, parkinsonism, and blue-man syndrome. It should be noted that intravenous amiodarone can cause hypotension. Notably, the first-published cases of amiodarone-induced visual and auditory hallucination and amiodarone-induced simultaneous damage to the liver, lungs, thyroid, and eyes were summarized. Flecainide can cause cardiac toxicities and organizing pneumonia. Flecainide overdose can cause altered mental status, seizure, and heart toxicity. Patients who have renal dysfunction or are poor metabolizers with a polymorphism on CYP2D6 may be highly susceptible to flecainide toxicity. No matter whether lidocaine is administered via infiltration injection, oral ingestion of lidocaine cream or topical lidocaine spray, or instillation to the bladder, lidocaine can cause status epilepticus, confusion, tachycardia, cardiac arrest, or death. Overdose of verapamil can cause hypotension, cardiac arrest, and metabolic acidosis. Intravenous lipid emulsion can be used to treat intoxications of flecainide, verapamil, or lidocaine. The first-reported cases of sotalol-induced IgA vasculitis and dobutamine-induced myoclonus in a patient on peritoneal dialysis were summarized. The studies summarized in this chapter raise awareness about rare or dangerous side effects of positive inotropes and antiarrhythmics.

During the 2018–2019 academic year, OMS‐II students at Rocky Vista University were introduced to pre‐recorded video lectures (PRVL) as a modality of learning and preparing for pharmacology clinical integration sessions. Traditionally, our university uses designated student assignments (DSA), traditional lectures, and clinical integration sessions (CIS) as methods of delivering pharmacology material. The purpose of adding PRVL was to introduce or “prime” students for future lectures and clinical integration sessions. In contrast to a flipped classroom, the PRVL simply highlight important concepts for lecture or introduce difficult subjects. They are meant to augment the other learning modalities, not to replace traditional lecture, which is typically seen in a true flipped classroom. We focused our research on assessing the efficacy of PRVL as measured by performance on exam questions. We hypothesized that access to PRVL would improve performance on pharmacology topics compared to previous classes at Rocky Vista University who did not have this additional resource. To determine whether students utilized the pre‐recorded video lectures, we administered a survey to all OMS II students, focusing on identifying which resources students used most often to learn pharmacology. Survey responses and student performance data were linked using participant numbers that were deidentified. Out of 271 total students, 97 students (a 35.8% response rate) responded to this voluntary survey. We found that 85% of survey respondents utilized the pre‐recorded video lectures >60% of the time. Comparing student performance on 30 pharmacology test items that assessed topics presented in PRVL, students who reported using PRVL <60% of the time scored slightly higher than students who used PRVL the majority of the time. In addition, 97% of students found PRVL to be a useful resource, but when asked whether it was the most useful resource of all modalities available, it was the least favored by students with only 8.2% of respondents preferring PRVL. These results are limited by small sample size, particularly in the group of students who used PRVL < 60% of the time (N=14). We hope to expand these findings by comparing cumulative performance on pharmacology test items before and after PRVL implementation.