The role of pharmacists in opioid stewardship: A scoping review

Gondora, Nyasha; Versteeg, Sarah G.; Carter, Caitlin; Bishop, Lisa; Sproule, Beth; Turcotte, Dana; Halpape, Katelyn; Beazely, Michael A.; Dattani, Shelita; Kwong, Mona; Nissen, Lisa; Chang, Feng Yee

doi:10.1016/j.sapharm.2021.06.018

Cited by 22 publications

(23 citation statements)

References 63 publications

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“…It is evident that pharmacists can and should play a critical role as active members of their patient's healthcare team. This is not only because they can provide timely access to therapy and contribute to patients’ continuity of care, but they are also medication experts who provide clinical support and expertise ( Gondora et al, 2021 ). The pharmacist's role is essential in OUD where patients need more personalized care.…”

Section: Discussionmentioning

confidence: 99%

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Bishop

Rosenberg‐Yunger

2022

Drug and Alcohol Dependence

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Introduction During the COVID-19 pandemic, patients with opioid use disorder (OUD) struggled with access to prescribers and opioid agonist therapy (OAT). Recognizing this gap in care, Health Canada issued a short-term subsection 56(1) class exemption from the Controlled Drugs and Substances Act authorizing pharmacists to independently manage controlled substances. The purpose of this study was to explore the expanded role of Canadian pharmacists in providing care to patients with OUD during the pandemic. Methods We conducted qualitative key informant telephone interviews in the fall of 2020 with Canadian pharmacists who used the exemption. We included community or primary healthcare team-based pharmacists who managed opioid medication under the exemption. We recorded, transcribed verbatim, and de-identified all transcripts. Data was analyzed using a thematic approach involving line-by-line coding and constant comparison. Results We interviewed nineteen pharmacists with representation from all provinces and urban and rural practice settings. Three major themes emerged that captured the pharmacists’ perspectives when providing care for patients with OUD during the pandemic: (i) continuity of care; (ii) harm reduction; and (iii) access to care. Pharmacists used the exemption to extend prescriptions, transfer prescriptions, receive verbal orders, and deliver OAT. Conclusions Throughout the pandemic, pharmacists were able to provide continuity of care to patients with OUD who would have otherwise been unable to access care. The exemption permitted pharmacists to assess patients and provide OAT through this expanded role. Other countries should look to the Canadian experience and leverage the expertise of the pharmacist to expand their scope so that they can help fill the gap in care for patients with OUD.

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Section: Discussionmentioning

confidence: 99%

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Bishop

Rosenberg‐Yunger

2022

Drug and Alcohol Dependence

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“…Pharmacists' education of patients and other healthcare professionals was associated with improved pain scores, enhanced knowledge and understanding as well as reducing opioid use. 32 A 2013-2015 survey of PCP referral patterns for patients with knee osteoarthritis (OA) found that out of 1000 visits, only 46 received PT referrals, and 221 received lifestyle counseling, while 498 received NSAIDs and 316 received opioids. 162 Pain medication referrals for knee OA increased from 2007 to 2015 with PT and lifestyle coaching appearing to be underutilized according to clinical guidelines.…”

Section: Helms Et Almentioning

confidence: 99%

“…For example, including a pharmacist as part of the interprofessional team has demonstrated improved functionality and symptom management, increased use of nonopioid pain medications, and a decrease in both opioid dose and opioid misuse risks. 31,32 For patients undergoing arthroscopic hip surgery, simply initiating a PT referral prior to opioid prescribing, compared to opioids before PT, resulted in reductions in total health care costs ($16 995 vs $18 806), total opioid supply (44 days vs 90 days), and percentage of patients that transitioned to chronic long-term opioid use (53%-70%). 33 Other nonopioid and nonsurgical treatment options for patients in CP include exercise, 34,35 cognitive behavioral therapy, 36 and sleep hygiene interventions.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional Active Learning for Chronic Pain: Transforming Student Learning From Recall to Application

Helms,

Frankart,

Bradner

et al. 2023

Journal of Medical Education and Curricular Development

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Chronic pain (CP) affects over 50 million Americans daily and represents a unique challenge for healthcare professionals due to its complexity. Across all health professions, only a small percentage of the curriculum is devoted to treating patients with CP. Unfortunately, much of the content is delivered passively via lecture without giving students an opportunity to practice the communication skills to effectively treat patients in the clinic. An interprofessional team of health educators identified 5 essential messages that students frequently struggle to convey to patients with CP. Those messages were based on interprofessional and profession-specific competencies to treat patients with CP from the International Association for the Study of Pain. The 5 messages highlighted the importance of (1) therapeutic alliance, (2) consistent interdisciplinary language, (3) patient prognosis, (4) evidence for pain medicine, surgery, and imaging, and (5) early referral to the interprofessional team. For each message, the team summarized relevant research supporting the importance of each individual message that could serve as a foundation for didactic content. The team then developed active learning educational activities that educators could use to have students practice the skills tied to each message. Each learning activity was designed to be delivered in an interprofessional manner.

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“…Although illicit opioids are a major contributor to the opioid crisis, there is evidence that a surge in opioid prescriptions may also be a key factor [4]. Pain is one of the most common reasons for accessing healthcare in North America, and one commonly used management approach is prescription opioids [5].…”

Section: Introduction 1overview Of the Opioid Crisismentioning

confidence: 99%

“…The repeated use of higher doses increases the potential for addiction [5]. In some situations, prescription opioids can lead to opioid misuse and an increased risk of progression to opioid use disorder (OUD) [4]. Individuals with OUD may access prescription opioids through various means including, but not limited to from one physician, from multiple physicians without informing them of other prescriptions (double doctoring), prescription fraud or forgery, theft, street drug markets, and Internet purchases [5].…”

Section: Introduction 1overview Of the Opioid Crisismentioning

confidence: 99%

Addressing the Opioid Crisis—The Need for a Pain Management Intervention in Community Pharmacies in Canada: A Narrative Review

Cid

2023

Pharmacy

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Background: The opioid crisis is a public health concern in Canada with a continued rise in deaths and presents a significant economic impact on the healthcare system. There is a need to develop and implement strategies for decreasing the risk of opioid overdoses and other opioid-related harms resulting from the use of prescription opioids. Pharmacists, as medication experts and educators, and as one of the most accessible frontline healthcare providers, are well positioned to provide effective opioid stewardship through a pain management program focused on improving pain management for patients, supporting appropriate prescribing and dispensing of opioids, and supporting safe and appropriate use of opioids to minimize potential opioid misuse, abuse, and harm. Methods: A literature search was conducted in PubMed, Embase and grey literature to determine the characteristics of an effective community pharmacy-based pain management program, including the facilitators and barriers to be considered. Discussion: An effective pain management program should be multicomponent, address other co-morbid conditions in addition to pain, and contain a continuing education component for pharmacists. Solutions to implementation barriers, including pharmacy workflow; addressing attitudes beliefs, and stigma; and pharmacy remuneration, as well as leveraging the expansion of scope from the Controlled Drugs and Substances Act exemption to facilitate implementation, should be considered. Conclusions: Future work should include the development, implementation, and evaluation of a multicomponent, evidence-based intervention strategy in Canadian community pharmacies to demonstrate the impact pharmacists can have on the management of chronic pain and as one potential solution to helping curb the opioid crisis. Future studies should measure associated costs for such a program and any resulting cost-savings to the healthcare system.

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The role of pharmacists in opioid stewardship: A scoping review

Cited by 22 publications

References 63 publications

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Interprofessional Active Learning for Chronic Pain: Transforming Student Learning From Recall to Application

Addressing the Opioid Crisis—The Need for a Pain Management Intervention in Community Pharmacies in Canada: A Narrative Review

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