Opioid Stewardship: Role of a Pharmacist

Pharmacists can play an enormous role in not only turning the tide of the opioid epidemic, but helping survivors on their road to recovery, consistent with a panel of experts hosted by hosted by the American Society of Health System Pharmacists (ASHP) during the 2020 ASHP Midyear Clinical Meeting and Exhibition.

The panel included Terri Jorgenson, RPh, BCPS of the Department of Veterans Affairs in Washington, DC; Amanda Hays, PharmD, MHA, BCPS, CPHQ of BJC HealthCare in St. Louis, Missouri; Samuel Stople, PharmD, MPH, of the National Quality Forum in Washington, DC; and Benjamin Michalove, PharmD, CPP, of the Charles George VA center in Asheville, North Carolina.

According to the experts, the opioid crisis has been compounded by the coronavirus disease 2019 (COVID-19) pandemic, which has decreased access to treatment and has increased social isolation. those that are battling addiction are increasingly isolated, and there are fewer distractions from addiction. In 2018, opioids were liable for 47,000 deaths. Medication for opioid use disorder (MOUD) is greatly underutilized despite being proven to scale back illicit opioid use, increase treatment retention, reduce cravings, and lower the risks of harm and death.

“As we all know , well beforehand of the COVID-19 pandemic, moving front and center to the consciousness of our health care system, we had another crisis that was considerably top of mind,” Stople said. “And that has not gone away. that’s the opioid epidemic. In fact, it’s only become more…problematic with COVID being present.”

Pharmacists, however, are positioned within the perfect place to assist stem the opioid epidemic. Pharmacists can help create a collaborative pain management program and help to develop new opioid stewardship strategies. These practice changes can help keep patients safe, while also ensuring effective look after pain management.

“The health care community as an entire has made significant progress in reference to the safe and appropriate use of opioid therapy” Michalove said. “The optimal evidence-based approach, being within the context of a multimodal interdisciplinary treatment plan, which we all know directly correlates with improved patient safety also as pain related outcomes. Standard opioid safety practices typically include routine safety monitoring and mitigation through urine drug screening, review of prescription state databases, and education consent agreements, also as naloxone distribution.”

One model practiced by the Veterans Affairs (VA) health care system places the main target on pharmacists developing practice integration tools that promote both efficacy and guideline-based clinical deciding . It also increases patient access to methods of managing OUD through their pharmacist. consistent with Michalove, opioid therapy follow-up notes are required every 3 months and is completed by an opioid prescriber. The notes evaluate the advantages of continuous opioid therapy. When a patient first starts opioids, they’re given but a 5-day supply, and an opioid renewal note is required by the patient at each renewal request. This has led the share of patients being dispensed opioids to fall from over 20% in 2015 to 10% in 2020, consistent with Michalove.

In the private sector, focus has been placed on emergency departments (ED). consistent with Hayes, BJC HealthCare hospitals have begun screening all patients upon arrival to the ED. A special emphasis is placed on harm reduction and a recovery couch has been deployed to the ED. During acute care, formulary limitations are placed on opioid use and discharge prescribing has been reduced.

“There are some benefits to you incorporating opioid stewardship concepts in your clinical pharmacy practice. It spreads, right? It helps others raise their awareness and other practitioners and team members hop on board with a number of those practices, just by the character of just doing it. i do know that sometimes it takes longer for culture change to happen, i feel we’ve all seen that with the opioid crisis and type of embrace that. But i will be able to also say that just doing it can go an extended way,” said Jorgenson.

Opioid stewardship may be a necessary practice for pharmacists, and that they should seek the required training, consistent with the presentation. Additionally, pharmacists should consider what aspects of opioid stewardship are often integrated into their practice immediately.

REFERENCE

Jorgenson T, Michalove B, Hays A, Stolpe S. The Future of Safe Pain Care Starts Here: Eliminating Missed Opportunities and Connecting Care with Pharmacist Providers. Presented at: 2020 ASHP Midyear Clinical Meeting and Exhibition; virtual: December 8, 2020.

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