Impact of Community Pharmacists on Reducing Opioid and Alcohol Co‐Use: A Pilot Randomized Control Trial of a Medication Therapy Management Intervention

Background Concurrent use of opioids and alcohol can result in respiratory depression, overdose, and death. Prior research has shown that 20%–30% of patients receiving opioid medications in community pharmacies engage in high‐risk drinking. We adapted a medication therapy management‐based intervention to address co‐use and tested its feasibility, acceptability, and preliminary efficacy. Design This pilot study enrolled adult, English‐speaking community pharmacy patients dispensed opioids who reported current drinking. Participants were randomized to standard medication counseling (SMC) or alcohol‐targeted brief intervention‐medication therapy management (ABI‐MTM). ABI‐MTM included two pharmacist‐delivered sessions focused on reviewing medications/interactions, motivating participants to discontinue co‐use, and providing a written action plan. We assessed enrollment, retention, intervention delivery, satisfaction, drinks per drinking day (DDD), and daily morphine milligram equivalent (MME) at baseline, 2, and 3 months. Outcomes were analyzed using descriptive statistics and generalized linear mixed modeling. Results We enrolled 44 patients (110% of target; 22 per group). No significant differences were found in age (mean = 55.8), sex (female = 65.9%), race (White = 95.5%), education (> high school = 95.5%), or health insurance status (insured = 95.5%). Consent and retention rates exceeded 90%, session delivery was ≥ 95%, and ABI‐MTM satisfaction ranged from 79% to 89%. At 3 months, 59.1% of ABI‐MTM participants versus 45.5% of SMC achieved ≥ 30% reduction in DDD and/or daily MME. Mixed models showed ABI‐MTM recipients had 2.10 (95% confidence interval = 0.34–12.95) higher odds of achieving this reduction. Conclusion ABI‐MTM demonstrated feasibility, acceptability, and preliminary efficacy. A fully powered trial is warranted to evaluate broader implementation.