The Most Powerful Champion in the Battle Against Opioid Abuse May Be Your Pharmacist

When pharmacists are at the center of the healthcare team, they are uniquely positioned to fight the opioid crisis. Here's how.

In light of the nationwide opioid epidemic, many doctors have stopped prescribing opioids altogether. But this solution is oversimplified because some patients need the effective pain relief that opioids offer.

The underlying issue is not opioids themselves; it’s the mismanagement of pain. Patients who are prescribed opioids should be using the smallest amount that still offers pain relief and for the shortest duration possible. They also need to have their therapy closely monitored. It’s important for doctors to assess their patients’ risk of opioid dependence before they begin therapy. But they can’t do it alone.

Pharmacists are ideally situated to help manage the treatment of chronic pain and to ensure that medications are being appropriately used. According to one study, “Pharmacists are in a unique position not only to identify patients at risk but also to educate their patients about opioid misuse and the potential of addiction treatment to help with their problem.”[1] When it comes to resolving therapy issues, pharmacists are at the center of the healthcare team because they collaborate with doctors to make sure the patients are on the correct medications and they communicate with the patients to educate them about their prescriptions.

When it comes to prescriptions, the most effective way to combat the opioid crisis is an individualized approach. In the managed care environment, it is essential to have comprehensive review protocols to identify the likelihood of developing opioid dependence, control inappropriate prescribing, and identify patients with a legitimate need for pain medications.

Opioid dependency can start in as little as seven days, and in some cases less than that. Prescription starter dose limits for supplies of only 5 to 7 days have reduced the need for refilling opioids in over 70% in EmpiRx Health’s book of business. When prescribed for longer periods, abrupt discontinuation may result in withdrawal symptoms and higher rates of overdose, which sometimes leads to fatal outcomes.

In addition, a highly functional Fraud, Waste, and Abuse (FWA) program with appropriate identification criteria proactively identifies the offenders on both the doctor and patient side. These programs can save lives by preventing unanticipated events (such as addiction) that could lead to death.

For example, EmpiRx Health’s FWA criteria helped one of our pharmacists identify a patient who had become dependent on oxycodone, which was starting to negatively impact the lives of her and her family. Our pharmacist reached out to this patient’s doctor to clarify the correct dosages and learned that the patient had been inappropriately using her pain medication. A drug screen showed that this patient was using other opioids that had not been prescribed to her. As a result of this collaboration, the doctor started tapering the patient’s doses and prescribed other medications to help end her addiction.

Opioid misuse can be a direct result of inappropriate prescribing by doctors. Inappropriate opioid prescribing may be described as, “inadequate, continued, or excessive prescribing that poses high risk of morbidity and mortality.”[2] Inappropriate prescribing increases the chances of a patient overdosing on opioids. [3]

To address the opioid epidemic, the CDC recently revised its prescribing guidelines. It states, if the benefits of opioid use outweigh the risks, then it is important for the doctor to establish goals for the patient before starting therapy.[4] Pharmacists can help explain the risks and benefits to patients or counsel them about opioid overdose management.

The CDC guidelines strongly recommend that naloxone, the opioid antidote, should be prescribed to all patients who are prescribed opioids to be used in case of overdose. In recent years, naloxone has become readily available in places where opioid overdoses are common. However, the guidelines also state that “only laws allowing direct dispensing by pharmacists appear to be useful.”[5]

As one of the most trusted professionals in the healthcare domain, pharmacists are perfectly positioned to combat the opioid crisis because they can have peer-to-peer conversations with doctors to determine whether opioids are a necessary part of the treatment regimen. They can consult with doctors and educate them about prescribing the smallest effective dose, only raising it if the patient’s pain is not alleviated. They can also recommend prescribing the lowest effective dose (not to exceed a seven-day supply) and immediate release rather than extended release formulations.

While patients are taking opioids, their doctors and pharmacists should be in close contact with them for frequent evaluation of the patient to determine if treatment continues to be necessary, or if it would be better to taper the dose and ultimately discontinue opioid use to prevent symptoms of withdrawal.[4]

The opioid crisis is a complicated issue, but it’s important to view it through a clinical lens. EmpiRx Health understands that there is no one-size-fits-all solution when it comes to pain management and opioid addiction. But restricted prescribing is not the only solution. An individualized approach and close monitoring of opioid therapy is the first step in identifying a potential opioid use disorder. Pharmacists, regardless of their healthcare settings, can play an integral role in this approach by closely monitoring patient data to help identify potential overuse and abuse.

References:
1. Compton WM, Jones CM, Stein JB, Wargo EM. Promising roles for pharmacists in addressing the U.S. opioid crisis. Research in social & administrative pharmacy: RSAP. https://www.ncbi.nlm.nih.gov/pubmed/29325708. Published August 2019. Accessed January 2, 2020.
2. Kim, Brian, Nolan, et al. Inappropriate opioid prescribing practices: A narrative review. OUP Academic. https://academic.oup.com/ajhp/article/76/16/1231/5525025. Published June 28, 2019. Accessed December 19, 2019.
3. National Institute on Drug Abuse. Overdose Death Rates. NIDA. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Published January 29, 2019. Accessed January 9, 2020.
4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm. Published March 18, 2016. Accessed December 30, 2019.
5. Abouk R, Pacula RL, Powell D. Association between State Laws Facilitating Distribution of Naloxone and Risk of Fatal Overdose. JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2732118. Published June 1, 2019. Accessed January 14, 2020.

Research by: Jessica Lewis, PharmD candidate, EmpiRx Health intern

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