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Pharmacists are on the front lines of helping to curb abuse and misuse in the opioid epidemic. But how can you make this happen in the real world?
Pharmacists are on the front lines of helping to curb abuse and misuse in the opioid epidemic, according to two pharmacy educators who believe better communication with other health care providers and patients is one of the keys to success.
Dan Hartung, MPH, Associate Professor at Oregon State University’s College of Pharmacy, and Nicole O’Kane, PharmD, Clinical Director for HealthInsight Oregon, shared techniques pharmacists can use to help prevent opioid abuse during a recent Pharmacy Quality Alliance webinar.
And pharmacists’ intervention is certainly needed, since 250 million opioid prescriptions were dispensed in 2013 and opioids comprise two-thirds of all drug-related poisonings. The CDC and the FDA issued new guidelines for prescribing opioids in 2016, after injuries and deaths from opioids jumped in 2014. There was a 14% increase in opioid-related deaths in 2014 to 29,467.
Recognizing the need for pharmacist involvement, the Agency for Healthcare Research and Quality gave Oregon State University, Oregon Health and Science University and HealthInsight a three-year grant to develop training materials and a toolkit for pharmacists using Oregon’s Prescription Drug Monitoring Program (PDMP). The RESPOND Toolkit is being tested in some Oregon pharmacies and results are expected in the fall of 2018.
“Responsibility is on the prescribing provider, but also on the pharmacist. Because pharmacists are on the frontlines, we advocate for expanded roles for pharmacists to advocate for safer use of opioids,” Hartung said. As they develop the curriculum and toolkit, the researchers have held several focus groups with patients, pharmacists, and prescribers around the state.
“Pharmacists really perceive that their role in monitoring safe prescriptions should extend to opioids. They also felt their role should be to identify patients at high risk of opioid misuse who would benefit from early interventions and to act as a member of the care team, with opportunities to collaborate with prescribers,” Hartung said.
But pharmacists also expressed significant concerns about the challenges of querying patients about opioid scripts and working with other health care providers on this massive problem.
“I view my role as being highly responsible for abuse/misuse, but with very little resources/strategies to make this determination,” one pharmacist said during focus groups.
O’Kane shared several ways pharmacists can better communicate with other providers and patients when they have concerns. In focus groups, many pharmacists said they “didn’t want to be the bad guy or they were uncomfortable” talking about potential opioid abuse with patients.
“Make sure you are coming from a place of caring,” O’Kane said. “Before contacting their prescriber [after seeing a potential problem on the PDMP], inform the patient that you are concerned about his safety, first and foremost, and that you have concerns. Use nonjudgmental, supportive language.”
Ask patients open-ended questions and communicate about what is being done on their behalf, O’Kane suggested. “Inform them about the PDMP and why it’s being used as a safety tool for them. When approached from a safety standpoint, people have a hard time staying hostile, one pharmacist told us.”
Pharmacists should also practice motivational interviewing techniques so they are more comfortable when faced with a potentially difficult conversation with patients. “Ask questions like, ‘What’s working for you?’ Always ask permission, rather than telling the patient. For example, ‘I have some concerns. Do you think that this information would be helpful to you?’,” O’Kane said.
In addition, inform patients when you have reviewed their prescription history using the PDMP. “They have a legal right to know that you have reviewed their report and to see a copy of the printed report,” O’Kane said. Then, inform them of next steps and be sure to include an expected timeline, such as 24 hours.