Pharmacists’ Role in Reducing Problematic Opioid Use

A special issue of Pharmacy (ISSN 2226-4787). This special issue belongs to the section "Pharmacy Practice and Practice-Based Research".

Deadline for manuscript submissions: 30 September 2024 | Viewed by 5591

Special Issue Editor


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Guest Editor
Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, Scotland, UK
Interests: public health; harm reduction; community pharmacy; mixed methods; community health

Special Issue Information

Dear Colleagues,

Pharmacy and pharmacists have always had a role in reducing the misuse of opioids. In the past, this was more of a policing capacity in which pharmacists focused on preventing the misuse of opioids. However, this has changed as we have adopted a more caring approach from an understanding that opioid use can be problematic for individuals, by causing them harm, increasing the risk of overdose, and all the problems that can go along with drug dependence. Pharmacists’ role has developed into both a public health and clinical response to the considerable challenges faced by people struggling with pain management and or drug dependence. Pharmacists provide a range of services, care, and support that we want to highlight in this special issue of Pharmacy. From supporting people on opiate replacement treatment for drug dependence, identifying and providing harm reduction services to people using illicit/street drugs, providing specialist clinical support in drug treatment services, to providing new models of care and care pathways for those dependent to over the counter opioids or prescription opioids for pain. The aim of this special issue is to provide a platform to showcase novel and innovative practice and models of care.  We welcome a full range of research and evaluation methodologies.

Prof. Dr. Catriona Matheson
Guest Editor

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Keywords

  • harm reduction
  • community pharmacy
  • opioid misuse
  • public health
  • opioids
  • addiction
  • medication safety
  • medication-assisted treatment
  • harm minimization

Published Papers (4 papers)

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Research

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10 pages, 488 KiB  
Article
Influences of Software Changes on Oxycodone Prescribing at an Australian Tertiary Emergency Department: A Retrospective Review
by Giles Barrington, Katherine Davis, Zach Aandahl, Brodie-Anne Hose, Mitchell Arthur and Viet Tran
Pharmacy 2024, 12(2), 44; https://doi.org/10.3390/pharmacy12020044 - 1 Mar 2024
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Abstract
Opioid prescribing and dispensing from emergency departments is a noteworthy issue given widespread opioid misuse and diversion in many countries, contributing both physical and economic harm to the population. High patient numbers and the stochastic nature of acute emergency presentations to emergency departments [...] Read more.
Opioid prescribing and dispensing from emergency departments is a noteworthy issue given widespread opioid misuse and diversion in many countries, contributing both physical and economic harm to the population. High patient numbers and the stochastic nature of acute emergency presentations to emergency departments (EDs) introduce challenges for prescribers who are considering opioid stewardship principles. This study investigated the effect of changes to electronic prescribing software on prescriptions with an auto-populated quantity of oxycodone immediate release (IR) from an Australian tertiary emergency department following the implementation of national recommendations for reduced pack sizes. A retrospective review of oxycodone IR prescriptions over two six-month periods between 2019 and 2021 was undertaken, either side of a software adjustment to reduce the default quantities of tablets prescribed from 20 to 10. Patient demographic details were collected, and prescriber years of practice calculated for inclusion in linear mixed effects regression modelling. A reduction in the median number of tablets prescribed per prescription following the software changes (13.5 to 10.0, p < 0.001) with little change in the underlying characteristics of the patient or prescriber populations was observed, as well as an 11.65% reduction in the total number of tablets prescribed. The prescriber’s years of practice, patient age and patient sex were found to influence increased prescription sizes. Reduced quantity of oxycodone tablets prescribed was achieved by alteration of prescribing software prefill parameters, providing further evidence to support systems-based policy interventions to influence health care providers behaviour and to act as a forcing function for prescribers to consider opioid stewardship principles. Full article
(This article belongs to the Special Issue Pharmacists’ Role in Reducing Problematic Opioid Use)
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11 pages, 273 KiB  
Article
Identifying Prescription-Opioid-Related Risks Using Prescription Drug Monitoring Programs’ Algorithms and Clinical Screening Tools
by Louisa Picco, Monica Jung, Helena Cangadis-Douglass, Tina Lam and Suzanne Nielsen
Pharmacy 2023, 11(5), 164; https://doi.org/10.3390/pharmacy11050164 - 13 Oct 2023
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Abstract
Background: Pharmacists adopt various approaches to identifying prescription-opioid-related risks and harms, including prescription drug monitoring programs (PDMPs) and clinical screening tools. This study aims to compare ‘at-risk’ patients according to the published Australian PDMP algorithms with the validated Routine Opioid Outcome Monitoring (ROOM) [...] Read more.
Background: Pharmacists adopt various approaches to identifying prescription-opioid-related risks and harms, including prescription drug monitoring programs (PDMPs) and clinical screening tools. This study aims to compare ‘at-risk’ patients according to the published Australian PDMP algorithms with the validated Routine Opioid Outcome Monitoring (ROOM) clinical screening tool. Methods: Data were used from an implementation study amongst people who had been prescribed regular opioids. We examined the results from ROOM and the patients’ dispensing history over the previous 90 days. A chi-squared test was used to examine the association between risk according to (i) a PDMP alert and a clinical risk per ROOM; (ii) a PDMP alert and positive screening for opioid use disorder; and (iii) a PDMP ‘high-dose’ alert (average of >100 mg OME/day in the past 90 days) and any ROOM-validated risk. Results: No significant associations were found between being ‘at-risk’ according to any of the PDMP alerts and clinical risk as identified via the ROOM tool (x2 = 0.094, p = 0.759). There was only minimal overlap between those identified as ‘at-risk’ via PDMP alerts and those meeting the clinical risk indicators; most patients who were ‘at-risk’ of clinical opioid-related risk factors were not identified as ‘at-risk’ based on PDMP alerts. Conclusions: PDMP alerts were not predictive of clinical risk (as per the ROOM tool), as many people with well-established clinical risks would not receive a PDMP alert. Pharmacists should be aware that PDMPs are limited to identifying medication-related risks which are derived using algorithms; therefore, augmenting PDMP information with clinical screening tools can help create a more detailed narrative of patients’ opioid-related risks. Full article
(This article belongs to the Special Issue Pharmacists’ Role in Reducing Problematic Opioid Use)

Review

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22 pages, 654 KiB  
Review
Organizational Readiness to Implement Community Pharmacy-Based Opioid Counseling and Naloxone Services: A Scoping Review of Current Practice Models and Opportunities
by Lindsey Hohmann, Klaudia Harris, Yi Zhao, Karen Marlowe, Haley Phillippe, Chris Correia and Brent Fox
Pharmacy 2023, 11(3), 99; https://doi.org/10.3390/pharmacy11030099 - 11 Jun 2023
Cited by 2 | Viewed by 1536
Abstract
The purpose of this study was to explore existing practice models and opportunities surrounding community pharmacist-delivered opioid counseling and naloxone (OCN) services in the U.S., with the goal of enhancing organizational readiness and improving patient access. A scoping literature review was conducted. English-language [...] Read more.
The purpose of this study was to explore existing practice models and opportunities surrounding community pharmacist-delivered opioid counseling and naloxone (OCN) services in the U.S., with the goal of enhancing organizational readiness and improving patient access. A scoping literature review was conducted. English-language articles published in peer-reviewed journals from January 2012–July 2022 were sought via PubMed, CINAHL, IPA, and Google Scholar using permutations of terms such as “pharmacist/pharmacy”, “opioid/opiate”, “naloxone”, “counseling”, and “implement/implementation”. Original articles reporting the resources/inputs (personnel; pharmacist full-time equivalents; facilities and expenses; in-house versus outsourced personnel), implementation processes (legal source of pharmacist authority; patient identification strategies; intervention procedures; workflow strategies; business operations), and programmatic outcomes (uptake and delivery; interventions made; economic impact; patient or provider satisfaction) of pharmacist-delivered OCN services in community (retail) settings were retained. Twelve articles describing ten unique studies were included. The studies primarily used quasi-experimental designs and were published from 2017 to 2021. The articles described seven broad program elements/themes: interprofessional collaboration (n = 2); patient education format including one-on-one patient education (n = 12) and group education sessions (n = 1); non-pharmacist provider education (n = 2); pharmacy staff education (n = 8); opioid misuse screening tools (n = 7); naloxone recommendation/dispensing (n = 12); and opioid therapy and pain management (n = 1). Pharmacists screened/counseled 11–2716 patients and provided 11–430 doses of naloxone. Limited implementation costs, patient/provider satisfaction, or economic impact measures were reported. This review may serve as a guide for community pharmacists in implementing OCN services in their own practices. Future studies should clarify OCN program implementation costs, patient/provider satisfaction, and the economic impact. Full article
(This article belongs to the Special Issue Pharmacists’ Role in Reducing Problematic Opioid Use)
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Other

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9 pages, 529 KiB  
Opinion
Empowering Pharmacists: Strategies for Addressing the Opioid Crisis through a Public Health Lens
by Tamera D. Hughes, Juliet Nowak, Elizabeth Sottung, Amira Mustafa and Geetha Lingechetty
Pharmacy 2024, 12(3), 82; https://doi.org/10.3390/pharmacy12030082 - 23 May 2024
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Abstract
Background: The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. Results: This commentary examines five determinants of public health in relation to pharmacist-led [...] Read more.
Background: The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. Results: This commentary examines five determinants of public health in relation to pharmacist-led interventions for the opioid crisis: individual behavior, social factors, policymaking, health service accessibility, and biological/genetic considerations. Pharmacists can influence individual behavior through education and support, address social determinants like stigma, advocate for policy changes, ensure health service accessibility, and personalize opioid prescriptions based on biological factors. Conclusion: Pharmacists play a crucial role in addressing the opioid crisis by navigating these determinants. Pharmacists’ engagement is essential for reducing opioid-related harms and improving public health outcomes through advocacy, service provision, and education. Full article
(This article belongs to the Special Issue Pharmacists’ Role in Reducing Problematic Opioid Use)
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