Efforts to address the opioid epidemic are as complex as the problem, with involvement ranging from government agencies to state pharmacy boards to addiction specialists to medical professionals.
Pharmacists may be the first to suspect opioid abuse and misuse, and many have altered the way they interact with patients who take opioids. Studies have found that pharmacists say the epidemic has changed the way they counsel patients about pain management and potential problems.
“A growing awareness of the dangers posed by prescription opioids seems to be leading to more proactive discussions between pharmacists and patients regarding this issue,” says Lucas Hill, PharmD, BCPS, BCACP, clinical assistant professor at the University of Texas at Austin College of Pharmacy.
Here are some of the biggest ways pharmacy practice is changing.
1. Adopting New Protocols
Some chain and independent pharmacies are implementing policy changes to protect patients and pharmacists. CVS, for example, has strengthened counseling for patients filling a first-time opioid prescription.
“During this counseling, our pharmacists will talk to the patient about the recommendations from the CDC around opioid use,” says Tom Davis, RPh, vice president for pharmacy professional services at CVS Pharmacy. “The key message to patients initiating opioid treatment for an acute use is to use the lowest effective dose for the shortest possible duration of time. Pharmacists will also talk to patients about the importance of safely storing and appropriately disposing of opioids to prevent misuse or diversion.”
CVS uses the CDC Guideline for Prescribing Opioids for Chronic Pain to frame its prescribing policy, limiting the supply of opioids dispensed for certain acute prescriptions to seven days for patients new to the therapy.
“The program also employs MME [morphine milligram equivalent] limits consistent with the CDC Guidelines,” Davis tells Drug Topics. “And, it requires the use of immediate-release formulations of opioids before extended-release opioids are dispensed.” These changes went into effect in September 2017.
Tana Kaefer, PharmD, clinical coordinator at Bremo Pharmacies in Richmond, VA, says her protocol is to emphasize opioid alternatives. “If the patient gets two prescriptions, one for ibuprofen and one for an opioid, I may tell them to try the ibuprofen first.”
Up next: More steps pharmacists are taking