Evaluating pharmacist workforce initiatives to expand substance use services in Indian Country

American Indian and Alaska Native (AI/AN) communities experience a disproportionate burden of substance use disorders (SUD), with inequities tied to rural, under-resourced contexts in which many AI/AN people live and insufficient access to treatment. Enhancing pharmacy workforce capacity across Indian Country represents a key opportunity to address SUD treatment gaps.

We sought to evaluate an Indian Country pharmacist workforce development program, including satisfaction; changes in SUD knowledge, confidence, and skills; and barriers and facilitators to implementing SUD services.

Participants in an 8-to-12-week mentoring program conducted between May 2024 and June 2026 completed a post participation mixed-methods, web-based survey, including measures adapted from the Prescriber Satisfaction with Academic Detailing (PSAD). Participants also received a follow-up email to assess service changes since participation. Quantitative data were analyzed descriptively using counts and proportions. Qualitative data were analyzed thematically and synthesized to generate common themes.

There were 32 program participants across eight cohorts, representing 13 states, and nine IHS areas. There were 32 (100%) survey responses, among which 84%-100% expressed high satisfaction (i.e., selecting "very or extremely") across PSAD questions. Most respondents reported their opioid related knowledge (88%), confidence (91%), and skills (69%) "improved a lot"; approximately one-third reported their stimulant related knowledge (34%), confidence (34%), and skills (31%), and alcohol related skills (38%) "improved a lot" and nearly half reported their alcohol related knowledge and confidence "improved a lot" (44% and 47%, respectively). Three participants reported starting at least one new patient on buprenorphine in post-participation follow-ups. Respondents shared motivational and logistical barriers, and suggested supports at individual, community, and administrative levels, to implementing SUD services.

This program increased pharmacists' confidence, knowledge, skills related to SUD treatment. Future programs should integrate site-specific training to further expand pharmacist skills and access to SUD services for AI/AN people.