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September 30, 2019

ASHP Opioid Task Force Focuses on Role of Pharmacists in Combating Opioid Crisis

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

This week we look forward to convening an Opioid Task Force meeting to address the important roles pharmacists play in combating the opioid crisis, a multifaceted issue that requires sustained efforts by all members of the interprofessional care team. While no easy fixes exist to end the opioid epidemic, ASHP and our 50,000 members have been working diligently to shape the solutions around opioids through the engagement of pharmacists on behalf of our patients and communities. Still, there is far more work to be done.

The interdisciplinary ASHP Opioid Task Force, chaired by Past President Lisa Gersema, is charged with identifying actionable solutions, tools, and resources to help address the national opioid epidemic through the engagement of pharmacists as medication therapy experts, clinicians, and providers on the interprofessional team. Key areas of focus include:

  • Identifying the roles that pharmacists play in initiating, building, and growing opioid stewardship.
  • Identifying best medication-related pain management prescribing practices that optimize the use of non-opioid therapies.
  • Identifying the public health roles that pharmacists play in their communities as related to the prevention and treatment of opioid use disorders.
  • Developing recommendations on a solutions-focused public policy agenda.
  • Identifying education, tools, and other resources to help hospitals and health systems address the opioid crisis, including in areas related to drug diversion prevention and mitigation.

The ASHP Opioid Task Force will examine how pharmacists can drive practice changes, community-wide opioid-related efforts, and policy solutions. The recommendations will be reinforced by the breadth and depth of expertise of each Task Force member, many of whom have direct experiences with developing opioid stewardship programs, policies to increase access to medication-assisted treatment, opioid-related community programs, and shaping the national agenda to address the epidemic. The Task Force will be working to finalize its recommendations in the forthcoming months. The outcomes of the Task Force will be published in a spring issue of the AJHP and shared widely with our membership, partners, and external stakeholders.

As discussed in a previous blog, ASHP is a sponsoring member of the National Academy of Medicine (NAM) Action Collaborative on Countering the U.S. Opioid Epidemic. ASHP will be sharing the outcomes of the Task Force with NAM to contribute and support the larger national dialogue around opioids. ASHP serves on the Action Collaborative’s Pain Management Guidelines and Evidence Standards Working Group and Prevention, Treatment, and Recovery Services Working Group. As the Action Collaborative works to further synthesize and amplify evidence-based medicine to prevent and manage opioid use disorder, ASHP is committed to highlighting the role of the pharmacist throughout.

We look forward to sharing more about our work with the ASHP Opioid Task Force and on ASHP’s ongoing efforts surrounding the opioid crisis, including creating various tools, education, and resources to support you in your practice.

As this work moves forward, I urge you to review ASHP’s current resources on the topic, including our toolkits on pain managementcontrolled substances management, and opioid management.

Click here to view the complete ASHP Opioid Task Force roster.

Thank you for being a member of ASHP, and for everything that you do for your patients.

Sincerely,

Paul

December 18, 2018

ED Pharmacists Keep Opioid-Naive Patients Naive

ED pharmacists Zachary Brent, Pharm.D., BCPS, and Julie Bennett, Pharm.D., MBA, BCPS, discuss opioid metrics.

IN THE EMERGENCY DEPARTMENT (ED) of Baptist Memorial Hospital in Memphis, Tenn., an innovative opioid stewardship program is showing real promise in keeping opioid prescriptions to a minimum while making sure patients are comfortable and pain-free. The program’s primary goal is to keep opioid-naive patients naive.

Opioids in the ED

“Opioids are an increasing problem in the ED, not because pharmacists are seeing so many more overdoses — those are often treated by EMTs — but because the ED is often where a patient is first exposed to opioids,” explained Julie Bennett, Pharm.D., M.B.A., BCPS, a pharmacist who works in Baptist Memorial Hospital’s bustling ED. “We realized that if we could find a way to eliminate that first exposure, then we could make a significant impact on the opioid crisis.”

With the full support of Baptist Memorial’s ED physicians and leadership, Dr. Bennett and Zachary Brent, Pharm.D., BCPS, also an ED pharmacist at Baptist Memorial, set out to create an opioid stewardship program that offers opioid alternatives to patients.

The two pharmacists, both members of ASHP, began the project in January 2017 by collecting data on opioid usage in Baptist Memorial’s ED. They chose milligrams of morphine equivalents per 100 emergency department patient visits as the primary metric. The data showed that in January 2017 the ED staff was giving 120 mg morphine equivalents per 100 ED patient visits. “This was sobering,” said Dr. Brent. “We were giving a dose of opioids to one out of every four patients in the ED.”

Opioid Alternatives

To reduce opioid dispensing, the hospital’s pharmacy team created an opioid stewardship program based on a program implemented at the Swedish Medical Center in Englewood, Colo. First, the Baptist Memorial pharmacy team identified five conditions that are typically treated with opioids: chronic abdominal pain, headache/migraine, renal colic, extremity fractures/joint dislocations, and musculoskeletal pain. The team then provided physicians with non-opioid alternative treatment options for each condition.

Dr. Bennett orders medications from an automated dispensing system.

“Treatment options are broken down into first-, second- and third-line options,” said Dr. Brent. “For example, first-line treatment for headache/migraine might include a liter of saline plus oxygen, ketorolac, ketamine, or lidocaine injections. A physician might choose one, two, or even three of these options.”

He noted that many of the first-line options are common OTC pain medications, but in IV form. “All of the treatment options are built into our computer physician order entry system so our physicians can easily access and order these alternative pain medications,” said Dr. Brent. “Most of the alternative options are also stocked in our automated dispensing cabinets in the ED to allow for quick retrieval by nurses.”

If an opioid is needed, then the pharmacy team will try to use the lowest effective dose. “If patients come in on opioids, that’s fine, but it doesn’t necessarily mean that we are going to give them opioids while they are in our ED,” said Dr. Brent. “The alternative medications we use tend to work quicker and more effectively to alleviate patients’ pain.”

For example, Dr. Bennett recalled a recent situation where a patient who used morphine and oxycodone at home for a certain condition wanted a prescription from the ED pharmacist to alleviate pain caused by her shoulder bursitis. “She already had topical lidocaine patches and creams and every other alternative I could think of at home,” said Dr. Bennett, who ultimately recommended a nonsteroidal anti-inflammatory drug called ketorolac. The patient remembered that she received ketorolac for a dental procedure and that it had really helped with the pain.

Communication and Education

Soon after rolling out the new opioid stewardship program, the pharmacists experienced a bit of pushback from physicians who were used to ordering opioids and from patients who expected to get them. The pharmacy team used a combination of communication and education to demonstrate why opioid alternatives can often be a better option.

ED physician Katrina Hutton, D.O., and Dr. Bennett talk about opioid alternatives for a patient being discharged.

On the patient side, the pharmacy team assisted nurses with answering patients’ questions about the alternative medications and made sure that patients’ pain needs were always being met. “There were many times when I was called to a room to explain to a patient how the alternative medication works and why it is better than an opioid,” explained Dr. Brent. “Sometimes the patient was satisfied with the explanation, and other times they weren’t.” He believes the conversations with patients helped them understand that the providers in the ED were trying to do what was best for them, instead of just defaulting to using opioids.

Although the physicians were excited about the change and enthusiastic about providing more appropriate care for their patients, “it was still difficult for them to curb their opioid use, since it was a habit for them to order opioids,” said Dr. Brent. “Once our providers knew they had support [from hospital leadership], and we provided them with the order sets and educated the nurses about opioid alternatives, they were all in.”

Satisfied Patients, Satisfied Providers

As a result of implementing the opioid stewardship program in the ED at Baptist Memorial, opioid use decreased by 73 percent. Where previously one out of four patients received a dose of an opioid in the ED, the number has now dropped to 1 out of 10. Patient satisfaction with how they felt their pain was being addressed increased by around 30 percent.

Dr. Brent believes the entire team of ED pharmacists, physicians, and nurses at Baptist Memorial has done a great job of communicating to the patient why they are being given an opioid alternative. “We are all focused on taking care of patients effectively and efficiently,” said Dr. Brent. “Through the opioid alternative program, pharmacists are providing physicians and nurses with the support to do that. ED pharmacists are in the perfect position to partner with our providers to give them the tools needed to take care of patients appropriately.”

 

By Ann Latner

 

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