From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.

www.clinicaltrials.gov , NCT 00878371. Registered 7 April 2009.

ObjectiveTo determine the effects of surgery‐induced inflammation on morphine distribution across blood‐brain barrier (BBB)MethodsBlood and cerebrospinal fluid (CSF) concentrations of morphine were measured in adult patients undergoing aortic aneurism surgery with (n=12) and without (n=13) cardiopulmonary bypass (CPB). Morphine concentrations were determined by mass‐spectrometry. A Q‐plex cytokine ELISA was used to measure plasma and CSF cytokines.ResultsThe surgical inflammatory response was characterized by increased plasma concentrations IL‐6, a known regulator of BBB drug transporters. The plasma area under the curve from 0 to 24 h (AUC0–24h) of interleukin‐6 (IL‐6) was significantly higher (p=0.02) in the CBP (7900±8180 pg/ml h) versus the non‐CPB (1690±1680 pg/ml h) group, indicating that individuals receiving CPB had a more robust inflammatory response. The CSF to plasma AUC0–24h ratio of morphine in the CPB versus non‐CPB groups was 1.06±0.57 and 2.51±2.08 (p=0.03), respectively, indicating that less morphine penetrated into the brain following CPB when a larger inflammatory response was present.ConclusionCSF morphine exposure is lower in individuals undergoing aortic aneurism with CPB. This effect may be due to IL‐6‐mediated changes in blood‐brain barrier drug uptake or efflux transporter function.The HSFC, PEF and CAS funded the project.