In the midst of an opioid epidemic, mortality related to opioid overdose continues to rise in the US. Medications to treat opioid use disorder, including methadone and buprenorphine, are highly effective in reducing the morbidity and mortality related to illicit opioid use. Despite the efficacy of these life-saving medications, the majority of people with an opioid use disorder lack access to treatment. This paper briefly reviews the evidence to support the use of medications to treat opioid use disorder with a specific focus on methadone. We discuss the current state of methadone therapy for the treatment of opioid use disorder in the US and present logistical barriers that limit its use. Next, we examine three international pharmacy-based models in which methadone dispensing to treat opioid use disorder occurs outside of an opioid treatment facility. We discuss current challenges and opportunities to incorporate similar methods of methadone dispensing for the treatment of opioid use disorder in the US. Finally, we present our vision to integrate pharmacybased methadone dispensing into routine opioid use disorder treatment through collaboration between clinicians and pharmacies to improve local access to this life-saving medication. KEY WORDS: methadone; opioid use disorder; opioids.

IMPORTANCE An international expert committee recently revised its recommendations on amino acid intake for very preterm infants, suggesting that more than 3.50 g/kg/d should be administered only to preterm infants in clinical trials. However, the optimal amino acid intake during the first week after birth in these infants is unknown. OBJECTIVE To evaluate the association between early amino acid intake and cognitive outcomes at age 5 years. DESIGN, SETTING, AND PARTICIPANTS Using the EPIPAGE-2 (Epidemiologic Study on Small-for-Gestational-Age Children-Follow-up at Five and a Half Years) cohort, a nationwide prospective population-based cohort study conducted at 63 neonatal intensive care units in France, a propensity score-matched analysis was performed comparing infants born at less than 30 weeks' gestation who had high amino acid intake (3.51-4.50 g/kg/d) at 7 days after birth with infants who did not.

Objectives This study aimed to identify factors contributing to pharmacists’ engagement in vaccination services during the first influenza vaccination campaign in 2019–2020 for the Canadian province of Quebec, led by community pharmacists. Methods A mixed-methods study was conducted using a sequential exploratory design. Semi-structured interviews were administered to pharmacists and key informants (n = 23) and data were analysed according to the Consolidated Framework for Implementation Research in community pharmacy. The findings were then used to construct a survey of community pharmacists’ engagement in vaccination, which was tested in a Quebec urban community. The study participation rate was 34.6% (n = 29). Key findings Pharmacists expressed positive attitudes towards the implementation of vaccination services, following legislative reform. Factors such as previous involvement in vaccination campaigns and the number of pharmacists on duty were positively associated with engagement in influenza vaccination, whereas staff shortages and logistical problems were a barrier to engagement. Qualitative findings provided in-depth understanding of the value of interprofessional collaboration between pharmacists and nurses. Conclusions Vaccination in pharmacies is currently more reflective of individual choice than an indication of collective change in the profession. Logistical factors are key to enhancing the uptake of vaccination in community pharmacies throughout Quebec. External support from professional associations and interprofessional collaboration should be enhanced to promote the implementation of vaccination services in pharmacies.

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Context: Social determinants of health drivers of vaccine inequity and leading to higher risks of complication from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes in improve vaccination rates. Little is however known on how they define and target vulnerable communities. Objective: The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies. Methods: We performed a systematic search of the Embase and Medline database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion. Results: A total of 1039 articles were identified through the initial search and 63 articles met the inclusion criteria. The vast majority of the literature originated from the North America (n = 54, 86%) and was addressed influenza vaccination (n = 29, 46%), pneumonia (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them. Conclusion: Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies in order to overcome the specific barriers experienced by various groups.