Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy

Abstract

The opioid crisis represents one of the largest failures of our current health care system as it continues to claim lives at an unprecedented rate and has caused a devastating range of preventable morbidity. Although the availability of highly potent synthetic opioids has amplified the urgency of the crisis for patients and communities, this problem has evolved over several decades. Pharmacists are in a position to offer many potential solutions due to their widespread accessibility, extensive drug knowledge, and integration into various health care settings. This opinion paper challenges the status quo by calling on all pharmacists to embrace evidence‐based opioid stewardship and harm reduction practices, contribute to the medical management of opioid use disorder, and address the misconceptions and prejudices that serve as barriers to effective, compassionate patient care. Regardless of practice setting or available resources, pharmacists can take deliberate and impactful steps to address the opioid crisis. Some pharmacists may be positioned to implement innovative and far‐reaching pharmacist‐led clinical services, while others may simply begin with careful consideration of the language they use when speaking to and about patients with substance use disorders. To optimize patient outcomes, the ineffective laws, regulations, and policies that negatively impact pain and addiction care must be addressed so that evidence‐based solutions can be widely disseminated. Pharmacists must aggressively advocate for the removal of barriers preventing high‐level clinical practice or policies that perpetuate patient harm and abandonment. Finally, there must be support for continued research on pain and opioid use disorder treatments and services, as well as the impacts of harm reduction practices and pharmacist‐led clinical services, so that resources can be allocated effectively.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Another programmatic systems approach to medication management endeavors to create a shared mental model using drug stewardship as a platform of organizational change [ 104 , 105 , 106 , 107 ]. While most stewardship programs have concentrated on rational antimicrobial use [ 108 ], recent developments have focused attention on medication classes that are frequently used in perioperative care and are high-risk for the patient, including opioids [ 109 , 110 , 111 , 112 , 113 ], anticoagulants [ 114 , 115 , 116 , 117 , 118 , 119 , 120 ], anemia management [ 121 , 122 , 123 , 124 , 125 ], and glycemic control with insulin [ 126 , 127 ], among others [ 4 ]. Table 5 summarizes recommendations for preventing VTE, SSI, PONV, POI, and PoD [ 128 ].…”

A safe in-home disposal system with every opioid prescription? Food and Drug Administration is considering a potential new Risk Evaluation and Mitigation Strategy that could impact pharmacists

“…Opportunities and challenges exist for pharmacists to play a larger role in mitigating problems associated with harmful use of opioids including distributing safe in-home disposal products for opioids. 37 Clayton Christensen and colleagues 38 wrote that innovation always pushes solutions closer to the consumer. Innovative in-home opioid disposal products or systems can optimize patient access to opioid disposal solutions and facilitate elimination of unused opioids from patients' homes as long as sufficient financial and technology resources are provided at the point of care for patients.…”

Evaluation of a Program to Screen Patients in Community Pharmacies for Opioid Misuse and Accidental Overdose

“…In October 2017, the Acting Secretary of Health and Human Services declared the opioid epidemic a public health emergency ( 1 ). Since then, national pharmacy organizations have banded together to empower pharmacists to take an active and preventive role in addressing the opioid crisis ( 2 , 3 ). In 2018, North Dakota reported that more than half of all drug overdose deaths were attributable to opioids ( 4 ).…”

“…Pharmacists in various practice settings have taken steps to prevent opioid misuse and accidental overdose ( 3 , 6 , 7 ). These steps include evaluating program information on prescription drug monitoring, dispensing naloxone, referring patients for substance use disorder treatment, and enhancing patient and pharmacist education ( 8 – 11 ).…”