Pharmacy and Pharmaceutical Sciences Commons^™

Nicotine Pouches: Harm Reduction Or Initiation Pathway? A Pharmacy-Focused Review, Emmanuel Fashesin Souza, Keykavous Parang

Pharmacy Faculty Articles and Research

Background

Nicotine pouches (NPs) are a rapidly growing category of tobacco-free oral nicotine products increasingly available in the community, including pharmacies. Whether NPs primarily function as harm-reduction tools for existing tobacco users or as a novel initiation pathway into nicotine and tobacco use, particularly among youth, remains a critical and unresolved clinical and public health question.

Objectives

To synthesize current evidence on the pharmacology, harm-reduction potential, and initiation risk of NPs; to compare NPs with U.S. Food and Drug Administration-approved nicotine replacement therapy and combustible cigarettes; and to identify implications and counseling priorities for pharmacy practice.

Methods

A narrative evidence …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

Implementation Of Wellness Activities In An Experiential Rotation To Promote Pharmacy Student Well-Being, Neeloufar Fakourfar, Brenda Kilzi, Reza Taheri, Richard Beuttler, Hindu Rao

Pharmacy Faculty Articles and Research

Background

Educational activity

Raising The Barb: Evaluation Of Phenobarbital Use For Alcohol Withdrawal In Patients On General Medicine Floors, Seth Arakawa, Jason Frederick, Anthony Le

Books, Presentations, Posters, Etc.

Abstract: Alcohol withdrawal syndrome (AWS) can present as a spectrum of symptoms such as a mild headache, gastrointestinal issues, and diaphoresis. However, if not treated properly, it can progress to severe hallucinations, seizures, or delirium tremens. Current guidelines from the American Society of Addiction Medicine (ASAM) recommend benzodiazepines as first line agents for alcohol withdrawal with phenobarbital recommended as an adjunct agent or replacement to benzodiazepines by providers who are familiar with its use. Although most evidence supporting phenobarbital in AWS comes from critical care settings, emerging data suggest it may also be safe and effective in general ward patients. …

Unlocking Hope: Mirtazapine's Promise In Obsessive-Compulsive Disorder Treatment, Rebecca K. Hicks, Iram Kingson, Jordan Gaal, Suzanne Holroyd

Marshall Journal of Medicine

Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). While selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are first-line treatments for OCD, a significant proportion of patients remain refractory to these interventions. Mirtazapine, an atypical antidepressant with unique pharmacological properties, has emerged as a potential adjunctive therapy for treatment-resistant OCD. This review synthesizes existing evidence regarding the efficacy and safety profile of mirtazapine in OCD management. We analyze clinical trials, observational studies, and case reports, distinguishing high- vs. low-quality evidence, and discuss mechanisms underlying mirtazapine's therapeutic effects. Additionally, …

Treatment For Women With Mental Health Disorders Associated With Reproductive Health: An Opportunity For Interprofessional Collaboration, Ellen Modlin Phd, Otr/L, Bcp, Caps, Deana Goldin Phd, Dnp, Arnp, Fnp-Bc, Pmhnp-Bc

Journal of Interprofessional Practice and Collaboration

Abstract

Purpose: This article proposes an opportunity for interprofessional collaboration between mental health practitioners (MHPs) and occupational therapy practitioners (OTPs) for the treatment of women experiencing mental health disorders (MHDs) associated with reproductive health (RH) changes throughout the lifespan. This collaborative approach have the potential to optimize women’s health care and mitigate the risk of fragmented care, as these conditions are highly complex.

Method: Peer- reviewed literature from mental health and occupational therapy (OT) research was reviewed and summarized. The search focused on the barriers and potential opportunities for collaboration between MHPs and OTPs in women affected with MHDs associated …

Gender Differences In The Association Between Adverse Childhood Experiences And Drug Use: Findings From A Community-Based Survey In China, Hongyun Fu, Elizabeth Monk-Turner, Xiushi Yang

Department of Pediatrics Faculty Publications

Background

While adverse childhood experiences (ACEs) are widely recognized risk factors for behavioral health problems, including drug use, prior research has largely been conducted in Western countries, focused primarily on males, and relied on convenience samples without comparison groups of nonusers. Limited work has examined the impact of ACEs on drug use in non-Western contexts. This study examines gender differences in the relationship between ACEs and drug use in China, using data from a population-based probability sample survey.

Methods:

Cross-sectional data were collected in 2019 from one city in Yunnan Province in Southwest China and one city in Guangdong Province …

Impact Of An Educational Intervention On Pharmacy Students’ Knowledge, Attitudes, And Confidence Regarding Alcohol And Substance Use Disorders, Lina Itenberg

Student Scholar Symposium

This study examines the impact of an educational intervention on student pharmacists’ knowledge, attitudes, and confidence regarding alcohol and substance use disorders (AUD/SUD) at Lipscomb University College of Pharmacy. Current literature denotes that student pharmacists often feel unprepared to address substance use disorder in practice. This study evaluates whether a targeted educational intervention can enhance student understanding of first-line pharmacological treatments, increase confidence in handling opioid-related emergencies, and improve their ability to educate patients on harm reduction strategies, including naloxone use and opioid overdose risks. Pre- and post-intervention surveys will assess changes in students’ preparedness and identify ongoing concerns about …

The Role Of Psilocybin In End-Of-Life Care: Evidence, Mechanisms, And Guidelines, Mackenzie E. Unsworth, Mary Lou Galantino, Robert Sandoval

Oncology Rehabilitation in Practice

This article aims to provide a brief overview of the evidence and mechanisms for psilocybin use in EOL care. Additionally, this article will provide guidelines for clinicians to assess patient use and integrate psilocybin into their clinical practice with respect to its current legal status.

Confronting The Mental Health Crisis: Structural Inequities, Market Pressures, And The Role Of Pharmacy Solutions, Kasi Gorli, Thomas L. Pile, Craig Kimble, Alberto Coustasse

Management Faculty Research

The mental health crisis in the US is severe, with depression and anxiety leading causes of disability among young adults. The mental health services market is growing, but access to care remains inconsistent, particularly in rural and underserved areas. Pharmacists are playing a crucial role in mental health care, improving medication adherence and patient outcomes through collaborative practice agreements. Systemic reform is needed to address barriers such as affordability and social determinants, with pharmacists integral to closing care gaps.

Use Of Naltrexone For Treating Binge Eating And Food Obsession Related To Trauma: A Case Report And Literature Review, Rebecca K. Hicks, Iram Kingson, Jordan Gaal, Suzanne Holroyd

Marshall Journal of Medicine

Impulse-control disorders, including those related to eating behaviors, are complex conditions with limited pharmacologic treatment options. While naltrexone is primarily used for opioid and alcohol dependence, emerging research suggests it may also be effective in managing a variety of impulse-driven conditions. As a pure opioid antagonist, naltrexone’s mechanism of action involves the inhibition of opioid receptors on dopaminergic neurons involved in the reward pathway of the brain, thereby reducing the reinforcing effects of substances such as alcohol and opioids. Research suggests that through this mechanism of action, naltrexone shows promise in treating impulsive behaviors also driven by the reward pathway, …

Pharmacogenetic Exploration Of Burenorphine And Related Metabolites In Umbilical Cord Blood, Amelia Monfared, Derek E. Murrell, Darshan S. Shah, Melissa Hoang, Stacy D. Brown, Sam Harirforoosh

Pharmacy Faculty Articles and Research

The goal of this study was to explore associations between single-nucleotide polymorphisms (SNPs) and umbilical cord blood concentrations of buprenorphine and its metabolites following maternal administration. This is a sub-study of a prospective observational cohort investigation which included pregnant women receiving buprenorphine for opioid use disorder during pregnancy. Following delivery, umbilical cord blood samples were collected and genotyped using a pharmacogenetic panel. The drug and metabolite concentrations were analyzed through liquid chromatography-mass spectrometry, and genetic association analysis was completed using PLINK software. The included neonates (n = 14) had a mean birth weight of 3.00 ± 0.39 kg and were …

Molecular Insights Into The Role Of Estrogen Receptor Beta In Ecdysterone Mediated Anabolic Activity, Syeda Sumayya Tariq, Madiha Sardar, Muhammad Shafiq, Hendrick Heinz, Mohammad Nur-E-Alam, Aftab Ahmad, Zaheer Ul-Haq

Pharmacy Faculty Articles and Research

Ecdysterone, often dubbed a “natural steroid,” has garnered significant attention among athletes for its reputed growth-promoting and anabolic properties. Unlike synthetic anabolic steroids, which are classified as controlled substances, ecdysteroids remain largely unregulated in many countries and are widely marketed as dietary supplements. Notably, ecdysterone has been included in the World Anti-Doping Agency (WADA) monitoring program, highlighting its potential impact on athletic performance and raising questions about its regulation. Emerging evidence indicates that, unlike traditional anabolic steroids that act primarily via the Androgen Receptor (AR), ecdysterone’s anabolic effects may be mediated through Estrogen Receptors (ERs), particularly Estrogen Receptor beta (ERβ). …

Fda Approves Lecanemab-Irmb Maintenance Dosing For Early Alzheimer’S Disease Treatment, Jordyn Linfield, Giang Nguyen, Ashley Jacob, Andrew Johnson, Maria Nguyen, Sara Ha, Joshua Honaker, Samantha Mccord, Kelly Kroustos

Pharmacy and Wellness Review

Alzheimer’s disease (AD) is the most prevalent neurodegenerative disorder and is associated with progressive and irreversible cognitive decline that begins with memory lapses leading to physical and functional impairment. The conventional therapies that have been used for the treatment from Alzheimer's Disease include acetylcholinesterase inhibitors and memantine, but additional therapy options are being developed. Lecanemab, brand name Lequembi, is currently a Food and Drug Administration (FDA) approved humanized monoclonal antibody for the treatment of Alzheimer’s disease and indicated for mild cognitive impairment (MCI) or mild dementia. While there is impactful aid for treatment, lecanemab has three significant adverse reactions, which …

A Local Assessment Of Glp-1 Use For Weight Loss: An Interview Study, Maci Bradley

Honors Theses

Glucagon-like peptide-1 (GLP-1) receptor agonists are a novel class of medications used primarily for the treatment of type 2 diabetes, as well as for chronic weight management. The first GLP-1 medication, exenatide, was FDA-approved in April of 2005 for glycemic control, however, it was not until December of 2014 when liraglutide became the first GLP-1 FDA-approved for weight loss. There are now eight FDA-approved GLP-1s, only two of which are approved for weight loss. GLP-1 use has become increasingly popular in recent years, even extending to the college-aged population. The purpose of this study is to examine the trends in …

The Impact Of Cocaine On Inflammatory Markers In Sim-A9 Microglial Cells, Tyler Vaglivelo

Honors Scholar Theses

Substance use disorders are conditions in which an individual continues to use a drug or other substance despite adverse consequences to their health and well-being. It has been hypothesized that inflammation within the central nervous system plays a critical role in the development of substance use disorders. The resident macrophages in the brain, also known as microglia, release markers of inflammation in response to injury or infection. A better understanding of the inflammatory response mediated by microglia in response to drugs of misuse can validate this hypothesis and help guide drug development. In the current studies, the microglia cell line …

Enhancing Holistic Patient Care Of Black Individuals Diagnosed With Hiv And Comorbid Chronic Conditions, Marc Fleming, Saharnaz Nejdat, Jon C. Schommer, Crystal K. Hodge

Pharmacy Faculty Articles and Research

Background

Pharmacists can play a crucial role in delivering the holistic care model. Research suggests that HIV-positive African American patients particularly benefit from this approach compared to other communities. Typically, pharmacists in community pharmacy settings are limited in their access to a patient's medical record, preventing holistic care delivery.

Objectives

This study addressed the impact of access to medical records on a holistic patient care approach among pharmacists engaged in medication therapy management.

Methods

This was a sub-analysis of a randomized controlled trial of the impact of community pharmacist access to medical records during MTM for African Americans diagnosed with …

Profit Over Patients: Examining The Influence Of Pharmaceutical Companies On Mental Health Medication Prescriptions, Allison Beltramini

Honors Projects in Biological and Biomedical Sciences

This paper explores the relationship pharmaceutical companies have with the overprescription of mental health medication, highlighting unethical marketing practices and their impact on prescription patterns. Previous literature addresses unethical pharmaceutical company marketing strategies, relationships within the field, and cost differences. This study includes qualitative insights from professionals in the field. Interviews conducted collected information that showed the prevalence of mental health illnesses, how treatments are prescribed, and the extent of pharmaceutical influence. Initial findings suggest a significant push for medication as it is the most common treatment method for mental health illnesses. This study highlights pharmaceutical companies' profit-driven motives and …

Contraceptive Hormone Influences On The Role Of Primary Reinforcement And Reinforcer-Enhancement In Nicotine Self-Administration, Kathleen Robin Mcnealy

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Hormonal contraceptives contain a synthetic estrogen (e.g., ethinyl estradiol/EE) and/or a synthetic progestin (e.g., levonorgestrel/LEVO) and can exacerbate nicotine intake. However, whether altered intake reflects changes in nicotine reinforcement or enhancement by nicotine of co-occurring reinforcers is unknown. This reinforcer-enhancement effect is evidenced in rats when nicotine self-administration is increased by the presence of a visual stimulus (VS) reinforcer. This dissertation examined the effects of EE and LEVO on nicotine reinforcement and reinforcer-enhancement in ovary-intact female Sprague-Dawley rats. Rats were implanted with a jugular catheter and assigned to receive daily injections of EE (Vehicle, 0.125 [Low], or 0.18 [High] μg/day; …

In-Silico Modeling And Characterization Of Kcc2 Protein Interaction With A Small Molecule Direct Agonist Identifies Potential Binding Sites For Modulating Behaviors Associated With Substances Of Abuse, William Hai Dang Ho, Alfred Amendolara, Kenyon Mitchell, Jaden Miner, Ruth Northcott, Braxton Bingham, Andrew J. Payne

Annual Research Symposium

Purpose

KCC2 is a potassium-chloride cotransporter that plays a critical role in neuronal function by regulating GABAergic signaling via chloride gradients. Maintaining this concentration gradient is crucial for balancing excitation and inhibition in the brain. While KCC2 dysregulation has been implicated in epilepsy and seizures, recent studies suggest that KCC2 inhibition results in phenotypes mirroring those seen in chronic opioid dependence. As such, increasing evidence support KCC2 being a potential therapeutic target for modulating behaviors associated with substances of abuse. Currently, only a few direct small molecule agonists against KCC2 have been reported, and no definitive active site on the …

Investigating The Effects Of Resveratrol On Opioid-Induced Hyperalgesia, Bryana Cox, Thien Do, Ashlyn Hughes, Zane Kingsbury, Keara Leroy, Andrew J. Payne

Annual Research Symposium

Opioid-induced hyperalgesia (OIH) is an adverse effect of chronic opioid therapy, characterized by increased sensitivity to pain. This study will seek to determine if using resveratrol supplementation as an indirect enhancer to increase the expression of the KCC2 membrane transporter can alleviate the symptoms of OIH in human subjects.

Chronic Heavy Alcohol Intake And Liver-Specific Lrp-1 Reduction Increase Amyloidosis In Alzheimer’S Disease Mice, Devaraj V. Chandrashekar, G. Chuli Roules, Ross A. Steinberg, Urvashi R. Panchal, Nataraj Jagadeesan, Adenike Oyegbesan, Trinh Roselyn, Joshua Yang, Sharda R. Bhagwat, Hiya Rakholia, Rutvi D. Mevawala, Moom Roosan, Derick Han, Rachita K. Sumbria

Pharmacy Faculty Articles and Research

Background

Chronic heavy alcohol drinking may be a modifiable risk factor for Alzheimer’s disease (AD), but studies in rodent AD models more closely mimic chronic moderate alcohol drinking in humans and largely focus on the brain. The role of the liver, which is significantly impacted by chronic heavy alcohol intake, in driving brain changes in alcohol-dependent AD remains unexplored. Our study using intragastric-ethanol feeding, which mimics chronic heavy alcohol intake in humans, in C57BL/6J mice showed significant AD-relevant changes in the brain and liver. Therefore, we aimed to investigate how hepatic changes using this model of chronic heavy drinking drive …

Nutrition Assessment Of Substance Use Population Compared To Control Population, Lalitha Indrani Dasari

Theses, Dissertations and Capstones

This study aims to evaluate and compare the nutritional status of individuals undergoing treatment for substance use disorder (SUD) with a matched control population. Poor nutrition, micronutrient deficiencies and malabsorption are common in individuals with SUD, potentially affecting recovery outcomes. This study involves collection of biometric data, demographic information, conducting a structured nutrition survey and performing a one-time blood draw of 35ml to assess key nutritional markers such as lipid panel, folic acid, vitamin B12, vitamin D, thyroid stimulating hormone (TSH), magnesium, selenium, chromium, zinc, copper and lithium. While the original protocol was designed to recruit approximately 110 participants across …

The Chemical Straightjacket: Institutional Over-Use Of Psychotropic Drugs On Children In Lieu Of Therapeutic Community Mental Health Services, Marisa Leib-Neri

Indiana Journal of Law and Social Equality

This Article argues that the abysmal state of children’s mental health in America is in part due to an overreliance on and over prescription of psychotropic drugs inside psychiatric residential institutions in lieu of community based mental health services. This overreliance on residential institutions and psychotropic drugs has allowed a new form of chemical restraint to flourish—the chemical straitjacket. This Article uses the medication lists of twelve children in seven different North Carolina psychiatric residential treatment facilities to demonstrate how the chemical straitjacket operates: the prescription of drugs not approved for pediatric populations, counter to evidence-based practices for particular diagnoses, …

Defederalizing Opioid Addiction Care, Matthew B. Lawrence

Faculty Articles

Lack of access to evidence-based care for drug addiction is an urgent problem amid a decades-long overdose crisis that kills tens of thousands of Americans a year. Opioid addiction is the primary driver of overdoses today, and medicines exist to treat such addiction that can dramatically improve quality of life while reducing the risk of deadly overdose by more than half. Yet fewer than one in four of the nine million Americans who need such evidence-based medical care for their addiction receive it. Chief among barriers to access are restrictive and burdensome federal requirements limiting the use of narcotic medications …

Residual Next-Day Effects Of Alprazolam On Psychomotor Performance And Simulated Driving In Healthy Normal Adults, Stevie C. Roszkowski, Shanna Babalonis, Marion A. Coe, Paul Nuzzo, Michelle R. Lofwall, Laura C. Fanucchi, Sharon L. Walsh

Center on Drug and Alcohol Research Faculty Publications

The prevalence of drugged driving has increased in the United States. Some drugged driving may be unintentional as prescription medications used as sleeping aids, like zolpidem, cause impairment after the predicted duration of therapeutic action has elapsed. The aim of this study was to determine if nighttime administration of alprazolam, a drug commonly prescribed off-label as a sleeping aid, impacts driving performance the following day. Participants were healthy adults (n = 15) who completed a double-blind, double-dummy, within-subjects inpatient study examining the effects of nighttime administration of alprazolam (0.5, 1, and 2 mg), zolpidem (10 mg), and placebo on driving …

Barriers To And Facilitators Of Buprenorphine Dispensing For Opioid Use Disorder: Evidence From Focus Groups In Appalachian Kentucky, Douglas R. Oyler, Dustin K. Miracle, Hannah Hesener, Laura Stinson, Monica Roberts, Adrienne Matson, Patricia R. Freeman

Pharmacy Practice and Science Faculty Publications

Background: As efforts to increase buprenorphine prescribing continue to intensify, pharmacy dispensing plays an important role in access to essential medications for opioid use disorder. Existing survey research suggests stigma and regulatory concerns are barriers to pharmacists dispensing buprenorphine, but facilitators are less clear, as are in-depth perceptions of pharmacists regarding buprenorphine.

Objective: To assess barriers and facilitators to buprenorphine dispensing in Appalachian Kentucky using a series of focus groups with pharmacy employees.

Methods: Between September and October 2023, 5 structured focus groups were conducted with a total of 19 pharmacists and pharmacy technicians across a mixture of high- and …

Anxiolytic Intervention: Modulation Of Cell Types Due To Nicotine Withdrawal, Taylor Elder

Theses and Dissertations--Pharmacy

Nicotine use disorder (NUD) remains a leading cause of preventable disease, yet the neurobiological mechanisms underlying nicotine withdrawal are incompletely understood. Emerging evidence implicates neuroimmune signaling and astrocytic regulation of glutamate in shaping the withdrawal-associated affective phenotype. This dissertation investigated these processes using multiple nicotine administration paradigms including osmotic minipump implant, cigarette smoke exposure, and nicotine vapor inhalation to model diverse routes of human nicotine intake.

Chapter 2 examines the effects of these three modes of administration on neuroinflammation and validation of nicotine delivery. Nicotine exposure was confirmed through receptor [³H]Epibatidine nAChR binding assay and serum cotinine measurements. …

Investigating The Role Of Dynamic Signaling Of Nrg3-Erbb4 In The Prefrontal Cortex In Mediating Nicotine Withdrawal Phenotypes, Emily Prantzalos

Theses and Dissertations--Pharmacy

While several pharmacotherapies are currently available for nicotine use disorder (NUD), smoking cessation success rates remain below 10% each year. The molecular mechanisms underlying failed quit attempts continue to represent a critical gap in our knowledge. However, recent advances in understanding the genetic contributions to nicotine dependence offer a promising avenue for developing more effective cessation therapies. Prior research has identified genetic variation in Neuregulin 3 (Nrg3) and its cognate receptor ErbB4 as potential contributors to affective nicotine withdrawal (WD) phenotypes and cessation outcomes. Therefore, this dissertation aims to systematically investigate the region-specific, functional role of the Neuregulin Signaling Pathway …

On! Original Flavor Oral Nicotine Pouch Characterization: Biorelevant In Vitro Nicotine Release Apparatus Assessment, Jason C. Funderburk, Melissa Morgan, Maria Lasaosa Garcia, Andreas S. L. Mendez, Matthew S. Halquist

Graduate Research Posters

Background: Oral nicotine pouch (ONP) use is rising. The sales of ONPs in 2019 were 126 million units, increasing to 808 million units in 2022. Understanding ONP in vitro release is critical for assessing exposure to ONP products.

Methods: The commercial brand ON! ONPs with nicotine label claims of 2, 4, and 8 mg, were evaluated in vitro for cumulative nicotine release using the bidirectional transmucosal apparatus (BTA) for 90 minutes. Nicotine quantification was performed by HPLC-PDA. For pH determination, ONP samples were prepared in water or artificial saliva (pH 6.8) with measurements for 30 minutes. BTA results were compared …