Kirk Evan Evoy

Introduction: Kratom and hemp-derived cannabinoid use has increased in the United States. Objective: Assess pharmacists’ perceived knowledge of kratom and hemp-derived cannabinoids and whether it improved following continuing education. Methods: This cross-sectional survey was administered to participants immediately before and after attending a live, one-hour continuing education presentation regarding the pharmacology, uses, risks, and legality of kratom and hemp-derived cannabinoids. The novel, investigator-designed, literature-informed survey assessed the frequency with which they were asked about kratom and hemp-derived cannabinoids in practice, perceived knowledge of the uses, risks, and legality of these substances, and participant’s perceived self-efficacy regarding counseling patients about them. The post-education survey also contained questions regarding perceived training value. Any pharmacist who attended the presentation and acknowledged consent was eligible to participate. Non-pharmacist attendees were excluded. Results: In total, 99 participants completed the pre-education survey and 63 the post-education survey. Most were never (81.8%) asked about kratom, while about half (48.5%) were never asked about hemp-derived cannabinoids, with 45.5% asked twice per month or less. Prior to education, most pharmacists did not feel confident discussing common uses, risks, or legal/regulatory status of kratom or hemp-derived cannabinoids and had limited understanding of distinctions between cannabis-related terms. Median pre-education scores ranged from 1-2 (out of 5) across all items. Following education, perceived knowledge and self-efficacy improved across all five items (all p<0.0001), each with post-education medians of 4. Conclusion: This exploratory study indicated that Texas pharmacists’ perceived knowledge of kratom and hemp-derived cannabinoids was low, but significantly improved following education on the topic. It also indicated they are not often asked about these substances in day-to-day practice, corroborating previous research that people who use these substances rarely discuss their use with their healthcare providers.

Pain is a key determinant of quality‐of‐life following breast cancer surgery, the most common cancer operation in the United States. Gabapentinoids are frequently prescribed for pain management, yet their respiratory, cardiovascular, and opioid‐related adverse effects remain unclear. This target trial emulation, analyzing US commercial claims (2013–2023), evaluated these safety outcomes under gabapentin–opioids initiation vs. opioids only during the first postoperative month following breast cancer surgery, with sustained 1‐year follow‐up. Women with nonmetastatic breast cancer were eligible on surgery dates if they had no prior outcomes, nor gabapentinoids or opioid prescriptions. Outcomes included time‐to‐first respiratory complications, major adverse cardiovascular events (MACE), arrhythmia, and high‐dose opioid utilization (≥ 50 or ≥ 90 morphine ‐milligram equivalent [MME]). We estimated 1‐year outcome risks and 95% CIs under gabapentin–opioids and opioids‐only strategies using weighted pooled logistic regressions with bootstrapping, including stabilized inverse probability weighting to adjust for baseline and time‐varying confounders. Of 86,290 eligible individuals, 1709 initiated gabapentin and opioids, and 39,372 initiated opioids only. Risks of respiratory complications (RR 1.24, 95% CI: 0.26–3.02), MACE (RR 0.95, 95% CI: 0.31–1.85), and arrhythmia (RR 0.65, 95% CI: 0.24–1.33) were comparable under gabapentin–opioids and opioids‐only. Risk of receiving opioid dosage ≥ 50 MME (RR 1.23, 95% CI: 0.85–1.72) and ≥ 90 MME (RR 1.09, 95% CI: 0.43–2.23) were comparable. This study challenged the limited evidence regarding safety concerns of adding gabapentin for pain management, finding that gabapentin–opioids initiation carried comparable respiratory and cardiovascular risks to opioids only following breast cancer surgery. However, we did not find evidence that adjunctive gabapentin reduces subsequent high‐dose opioid utilization.

Intro: Kratom use is growing for both therapeutic and non-therapeutic effects. This survey assessed the temporal relationship between kratom initiation and prior, subsequent, or concurrent substance use or medical treatment. Methods: This cross-sectional, anonymous electronic survey was disseminated to American Kratom Association and Global Kratom Coalition members from 3/2025-9/2025. Adults aged ≥18 years who reported past or current kratom use were eligible. A novel questionnaire was generated assessing: kratom and other substance use characteristics; pursuit of medical treatment for selected diagnoses; and temporal relationships between kratom use and substance use or medical treatment. Results: Of 161 respondents included, most (95.7%) currently versus previously used kratom. Whole-leaf product use was reported most often (90.3%), with 38.3% reporting concentrated kratom extracts and 16.9% single alkaloid isolates. Reasons for kratom use were therapeutic (50.3%), non-therapeutic (16.1%), or both (33.5%). Therapeutic (self-treatment) use was most commonly cited for pain (86.2%), mental focus (52.3%), mental health (46.9%), sleep (43.1%), and substance use disorder (27.7%). Most respondents had used ≥1 other psychoactive substance in their lifetime, including cannabis (74.3%), alcohol (68.2%), stimulants (43.2%), sedatives (33.1%), non-prescribed opioids (26.4%), or tobacco (6.1%); 10.1% reported no prior substance use besides kratom. Whether used for non-therapeutic or therapeutic purposes, kratom was rarely initiated first. Among those with a substance use history, only 3-10% reported trying kratom prior to other substances reported. Among those with pertinent medical conditions, 0-20% initiated kratom before receiving medical care for their reported conditions. Conclusion: This study builds on previous research assessing kratom use motivations, providing insight into the temporal relationship between kratom initiation and substance use or medical treatment. Kratom was rarely the first substance or therapeutic treatment tried, but rather most individuals initiated it concurrently with or after discontinuing other substances or medical care. Larger follow-up studies are warranted to confirm these results.

A 2017 systematic review and 2021 update identified 114 studies regarding gabapentinoid (gabapentin and pregabalin) misuse, dependence, or overdose. We aimed to update previous systematic reviews and describe new insights regarding gabapentinoid misuse. PubMed was searched from 1 September, 2020 to 24 January, 2025 using the following four searches: "gabapentin [MeSH] OR pregabalin [MeSH] OR gabapentinoid AND" one of the following four substance misuse-related terms: "substance-related disorders [MeSH]," "overdose," "abuse," or "misuse." Additional research was identified by reviewing papers cited by included studies. Studies presenting novel data regarding gabapentinoid misuse, dependence, or overdose were included. Non-English articles, review articles, and animal studies were excluded. One hundred studies (87 observational, 13 case reports/series) were included, from North America (33), Europe (39), Asia (20), Australia (7), and Africa (1). Sixteen studied gabapentin, 20 pregabalin, and 51 both medications. These studies corroborated previous findings that gabapentinoids are misused both for therapeutic and non-therapeutic purposes, often in conjunction with opioids or other substances, and commonly in people with substance use disorders and psychiatric conditions. Recent research built on the previous systematic review, providing more robust evidence that concomitant use with opioids or benzodiazepines increases overdose risks. New studies also highlight a growing body of evidence regarding misuse within the Middle East and North Africa, among adolescents, and in patients with chronic pain. Newly published evidence demonstrated that gabapentinoid misuse remains a significant concern, including in several populations not often highlighted in previous research. It provides more compelling evidence that gabapentinoids increase overdose risk, particularly when used with opioids or benzodiazepines.

Background: Patients with opioid use disorder need prompt buprenorphine/naloxone (BUP/NX) and naloxone nasal spray (NNS) access from pharmacies, but audit studies report substantial availability deficits. No specific intervention has increased BUP/NX stocking, and little is known about the impact of transitioning specific NNS formulations to over-the-counter. The purpose of this study was to assess the impact of mailed academic detailing on BUP/NX availability and the ability to obtain NNS without a prescription. Methods: A prospective interventional study was conducted in a sample of 1000 Texas community pharmacies assigned 1:1 to intervention and control groups. The intervention group received academic detailing handouts with links to continuing education addressing BUP/NX and NNS. Pre- and post-intervention audits were conducted using a telephonic secret-shopper approach. Outcomes for BUP/NX included stocking, willingness to order if not stocked, and a composite outcome of stocking and willingness to order. NNS outcomes included availability without a prescription. McNemar and Wilcoxon signed-rank tests, and generalized estimating equations (GEE) were used for analyses. Results: Data from 757 pharmacies were included in analyses (374 intervention, 383 control). Baseline BUP/NX stocking was low (36.7%) with no statistically significant pre-to-post changes for either group. Most pharmacies were willing to order (60.5%) with no significant pre-to-post changes for either group. GEE analysis found no significant difference in odds of stocking between groups (aOR = 1.08, P = .73), but the intervention group had a significantly higher likelihood to order (aOR = 2.25, P = .02) and of achieving the composite outcome (aOR = 2.17, P = .01). NNS availability increased in both groups but did not differ significantly between groups (aOR = 1.00, P = .99). Conclusions: A mailed academic detailing intervention did not change NNS availability or BUP/NX stocking but did modestly increase willingness to order BUP/NX. This intervention is easily replicable and scalable, but modifications to increase the magnitude of its effect are needed.

Since their emergence on the United States market in the early 2000s, e‐cigarette accessibility and use have grown considerably. Electronic cigarettes (e‐cigarettes), also referred to as vapes or electronic nicotine delivery systems, deliver their contents by heating and aerosolizing an “e‐liquid” that is then inhaled. This differs from traditional tobacco cigarettes (TC), which rely on combustion, a process that is responsible for many of the deleterious effects of smoking. As a result, e‐cigarettes are viewed by some as a potential harm reduction tool for those interested in quitting smoking TC. However, others are concerned that increasing use, particularly among adolescents and young adults, may reverse decades of progress toward a tobacco‐free society and lead to greater harms. As e‐cigarette accessibility and use grow, clinicians will continue to encounter more patients using e‐cigarettes who may be seeking assistance in quitting; therefore, it is crucial that clinicians remain aware of the literature to provide complete and accurate information to patients. Current evidence suggests e‐cigarettes may be efficacious as a harm reduction tool for those not yet ready to completely abstain from nicotine. However, their relative addiction potential, lack of long‐term safety data, and known or suspected cardiovascular, pulmonary, and carcinogenic risks suggest that for most patients who are ready to stop using nicotine completely, the US Food and Drug Administration‐approved pharmacotherapy options should still be the recommended first‐line options. Ultimately, if e‐cigarettes are used as a tobacco cessation tool, patients should be advised that the end goal should be to quit using these products entirely. While there remains an unmet need for additional research into e‐cigarette cessation interventions, the existing evidence to date supports the use of partial nicotine receptor agonists such as varenicline to assist with cessation.

Introduction: To address the opioid crisis in the United States, guidelines have prioritized non‐opioid therapies (i.e., non‐steroidal anti‐inflammatory drugs, acetaminophen), for postoperative dental pain. Complex cases may necessitate alternative analgesics, requiring careful pharmacotherapy management. Integrating pharmacists into dental care teams can optimize pain management and patient outcomes. This study evaluated a clinical interprofessional education (IPE) experience involving pharmacy and dental students in a geriatric oral surgery clinic. The objectives were to enhance students' knowledge and skills in managing postoperative pain and evaluate interprofessional behaviors within a clinical learning environment. Methods: From 2020 to 2022, third‐year pharmacy and dental students collaborated weekly in a geriatric oral surgery clinic which provided advanced dental procedures. Before clinic integration, students underwent a comprehensive orientation, including an IPE overview and profession‐specific student‐led trainings. Students collaboratively developed management plans integrating surgical and pharmacologic interventions. The Individual Teamwork Observation and Feedback Tool (iTOFT) was used to assess pharmacy student interactions. Pre‐ and post‐assessments evaluated students' pain management knowledge. A debriefing survey captured students' perceptions of pharmacy‐dental clinical collaborations. Results: Fifteen pharmacy and 33 dental students participated. iTOFT evaluations for pharmacy students highlighted strengths in shared decision‐making and patient‐centered care but revealed opportunities for improved team collaboration. Pharmacy students showed significant improvement in pain management knowledge (56.3% to 75%, p = 0.0137), while dental students' knowledge remained unchanged. Debriefing surveys revealed overwhelming positive perceptions, with 97.9% of participants reporting improved understanding of roles, mutual respect, and enhanced teamwork. Students expressed greater confidence in interprofessional collaboration, emphasizing the experience's value despite occasional role ambiguity. Conclusion: This deliberate, clinical IPE experience demonstrated significant benefits, including improved knowledge of pain management and positive attitudes toward interprofessional collaboration. Expanding similar initiatives can foster collaborative skills, fostering a comprehensive, interprofessional approach to patient care and addressing complex health care needs across diverse practice settings.