Project lifeline: implementing SBIRT in rural pharmacies to address opioid overdoses and substance use disorder.

Background: There is emerging recognition of the unique benefits of implementing screening, brief intervention, and referral to treatment (SBIRT) in pharmacy settings to identify patients who can benefit from services and connecting them to those services. Objectives: This study describes Project Lifeline - a multipronged public health initiative to provide educational and technical support to rural community pharmacies implementing SBIRT for substance use disorder (SUD) and providing harm reduction support. Methods: Eight community pharmacies were recruited. Patients receiving a Schedule II prescription were invited to engage in SBIRT and offered naloxone. Patient screening data and key informant interviews with pharmacy staff on implementation strategy were analyzed. Results: Between 2018-2020, 4,601 adult patients were offered screens and 3,407 screens were completed on 2,881 unique adult patients (51.3% female; <0.01% nonbinary; 95.7% White). Of these unique screens, 107 patients were indicated for brief intervention, 31 accepted the brief intervention; and 12 were given a referral to SUD treatment. Patients who declined SBIRT or who did not want to reduce their use were offered access to naloxone ( n  = 372). Key informant interviews highlighted the importance of person-centered staff education, role-playing, anti-stigma training, and integrating activities into existing patient-care processes. Conclusion: While ongoing research is needed to characterize the full impact of Project Lifeline on patient outcomes, the reported findings help reinforce the benefits of multipronged public health initiatives that include community pharmacists to address the SUD crisis.