Dr. Breckling is an Assistant Professor in the College of Pharmacy. She was recently awarded a $1M grant by the US Substance Abuse and Mental Health Services Administration (SAMHSA) to create a five-year program aimed at battling opioid overdoses with an Arkansas Naloxone Education Training (ANET) program.
Interview by Abigail Grimes, 2024, J.D. candidate
What drew you to being a pharmacist?
My mom is a nurse practitioner, so I grew up around healthcare and knew I wanted to help patients. I knew early on that I loved chemistry and learning about how drugs work. My mom encouraged me to learn more about pharmacy, so I started doing small research projects during undergrad, but I never thought I would be where I am now.
Dispensing medications and counseling people on medications is an important job for a lot of pharmacists. However, as I went through school, I realized I wanted to be a clinical pharmacist, and that led me to residency. Through the job I have now, I have developed an interest in research. I have a passion for advancing the roles of pharmacists and research is one way I can support it.
You were recently awarded a $1 million grant for a statewide Naloxone Training Program. How did you find out this grant was available?
I have really great mentors that have been doing grants for a long time. Two years ago, I took a position at UAMS that was supported by a grant. The position dealt with an interest of mine: educating healthcare providers. The funding for that position came from a grant that one of my mentors, Teresa Hudson, Pharm.D., Ph.D., received. Teresa is also a pharmacist, which is really cool, because pharmacists are often not thought of as being in Health Services Research roles. She has done some outstanding work, and she really inspired me.
Before starting in my current position, I had very little understanding about grants and how to write them. My research team and I were doing education on Naloxone through another grant at the time as a topic of education offered through the grant if the healthcare providers thought it was helpful. As it turns out, most of the healthcare providers picked Naloxone education as a topic, which made me realize people need more information and education about it.
I knew I wanted to continue expanding education on Naloxone. Teresa sent me an announcement for this current grant and encouraged our research team to apply. When we developed the application, we thought having a pharmacist as the director of the program would make sense, since pharmacists are medication experts. So, we decided I would oversee the program.
Full disclosure: I did not expect my first grant application to be awarded. I thought it would be a great learning experience, and I knew I would get helpful feedback. When we found out the grant was awarded, we were all so thrilled. My team was excited because the previous grant was about to expire, and we are all grant-supported. More importantly, this new grant is a way for us to continue the work we have been doing as a team. This will help make a difference statewide.
What other grant were you working on, and how does it relate to the funding for this new grant?
The other grant was submitted by the Department of Health in 2019, and UAMS was a partner on that grant. The original grant provided education on chronic pain management through academic detailing. Academic detailing is a method of educating providers through discussion of evidence-based information on specific topics. Through this method of learning, we facilitate discussions about barriers within specific patient environments, and then we tailor the education to fit providers’ specific needs. This educational method is personalized and is more one-on-one.
Because of the opioid epidemic, new guidelines have been released regarding prescribing opioids for chronic pain. A lot of healthcare providers have limited time to keep up with the new guidelines, or they do not understand the guidelines and their application. The goal of the other grant was tailoring our education to the opioid prescribing guidelines and communicating that to healthcare providers.
We developed an entire topic on Naloxone because opioids and Naloxone go hand-in-hand. Naloxone helps rapidly reverse an opioid overdose. Also, Arkansas law requires prescribers to prescribe Naloxone when prescribing certain amounts of opioids, and we want to help ensure compliance with state law.
Why are you passionate about this Naloxone education and training project?
This project is very personal to me because pharmacists are expanding our roles in health care. We are not just in traditional dispensing roles. I went through residency for clinical pharmacy in the VA system, where I was meeting with patients, prescribing medications, monitoring medications, and working with multidisciplinary teams. People may not realize pharmacists do all of that!
Pharmacists can take our role a step further when we educate others and use academic detailing. Because pharmacists are medication experts, it makes sense for us to be the ones educating others about medication management and addressing the real-life challenges. When I came to UAMS, I applied for academic detailing because I think it is beneficial for people to have up-to-date education on the evidence supporting medication management in various disease states, including substance use disorders.
Also, opioid use is very common for people struggling with chronic pain. I have seen that in my practice. I am passionate about this project because I want patients and family members to understand alternative pain management options, the full risks of the medications they are taking, and be prepared to respond to opioid overdose it the situation arises.
How will this training educate people about Naloxone?
The training will touch on motivational interviewing techniques. We want to give providers tools and phrases to use when they are talking with patients about opioids. There are so many misconceptions, and providers may not know how to start these conversations. This training will give providers the courage to start these conversations with their patients.
The training will also include how to recognize signs of opioid overdose and how to administer the life-medication, Naloxone. We will also include training on using additional resources that may be helpful for patients struggling with opioid use disorder.
What does your daily practice look like as a clinical pharmacist?
I have always enjoyed educating, whether it was to other healthcare providers, students, or myself. I knew that eventually, I wanted to be in a faculty role. I began at the UAMS system as a PRN in the clinic, and I did a research project educating healthcare providers at the same time. After a year or two, I started working with the Center for Implementation Research at the College of Pharmacy. Their goal is to implement different evidence-based interventions into policy and practice, which fits the work I was doing already.
I also work in a telepharmacy clinic two days a week, managing diabetes medications over the phone for rural healthcare clinics. I talk with them about their medications and blood sugar, and then I adjust their medications as necessary using an implemented protocol with their primary care providers. The other three days a week, I work on my research projects, which entails either educating healthcare providers, talking with them about a topic, and providing them with helpful resources.
For one of my other research projects, I travel to the Pulaski County Regional Detention Facility to provide education to incarcerated patients dealing with substance use disorders. This education has been focused on Naloxone and about medications for opioid use disorder.
My passion is really in implementation research, so I want to focus more on that, but I appreciate being in the clinic at least one day a week to stay current on what is happening in the clinic atmosphere.
How does it benefit patients when pharmacists work with physicians?
It is so cool to see pharmacists and physicians working together with patients. Of course, patients are still seeing the doctor every three to six months, but I communicate with the patients in the meantime. This way, patients are implementing the changes that their doctors wanted them to make. A team-based effort is important.
For example, with diabetic patients, it can be critical to adjust diabetic medications more frequently than patients may be able to visit doctors in person. I believe pharmacists could aid in the management of opioid use disorder treatment by providing referrals for patients or assisting with management of medications for opioid use disorder, especially in rural Arkansas. The expansion of telemedicine could help all Arkansans get access to the resources they need.
If you could do an ad for something cool in the tech world right now, what would it be?
I am a huge Kindle person. I love having my books wherever I am going. I used to carry three books around on vacation, so having all my books on my Kindle is nice. I also love pulling up the books I’m reading on my phone’s Kindle app!
What are you reading right now?
I have read a couple Colleen Hoover books. They have some very interesting plots and characters.
I have also been reading Undoing Drugs by Maia Szalavitz about how harm reduction is changing the future of drugs and addiction. I like to mix it up between reading fun books while also learning about work-related things.
What have you realized through your time at UAMS?
I realize I cannot do this on my own. My mentors and research team helped me figure things out when I knew very little about grants. Special thanks to Teresa Hudson, Pharm.D., Ph.D., Leah Tobey, PT, DPT, MBA, Mohab Ali, MBChB, and Amanda Lunsford for their support with this grant. I recognize that the work my team and I are doing really helps expand pharmacy practice. My overall goal is to help expand the roles of pharmacists in different environments to improve patient care.