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Collaboration between Physicians and Pharmacists to Combat the Opioid Epidemic

Written by Melissa Nguyen PharmD'19
Published on November 16, 2017

The physician is traditionally the “prescriber”, and the pharmacist is the “dispenser” in the management of pain and prescription opioids. In addition, the pharmacist and physician each have their own role in combating the Opioid Epidemic. In this crisis, the CDC estimates that 91 Americans die daily from an opioid overdose.  Furthermore, prescription opioids have driven an increase in deaths over the past 15 years. Due to these alarming numbers, having a “pharmacist-centered” or “physician- centered” approach to solve the Opioid Epidemic may not be adequate. Although physicians and pharmacists have separate roles, their practices come hand in hand when it comes to managing pain. This blog will overview how pharmacists can work with physicians to solve the Opioid Epidemic.

Counseling is key when it comes to deterring opioid misuse. While healthcare professionals are aware of this, in the emergency department, physicians and nurses may not be able to deliver enough counseling because they are in such a fast-paced environment. They may miss some important counseling points such as abuse potential and how to properly store and dispose of opioids. This may be problematic considering emergency medicine physicians prescribe 25% of all opioids. This overprescribing could put patients at risk of iatrogenic long-term misuse. The American College of Emergency Physicians have addressed a need for patient education in the emergency department. While they recognize that pharmacists can counsel patients at the pharmacy, they can be effective in the emergency department as well. Pharmacists and pharmacy students can fill in the gap between the physician or nurse and patient. They can briefly discuss and provide educational materials on how to safely use opioids as intended, storage, disposal, signs of overdose, and naloxone use. During this conversation, the pharmacist or pharmacy student can assess the patient’s previous pain medication use and risk of addiction. With this additional counseling provided by pharmacists, the iatrogenic misuse of opioids can be avoided.       

While opioids are typically prescribed for chronic pain, after surgery an opioid may be temporarily warranted for acute pain. In order to effectively manage a patient’s acute pain, pharmacists and pharmacy students can lead an opioid exit plan (OEP) for the patient. Pharmacists are tasked with collecting information and counseling the patient during admission, pre- and post- operation, and discharge. Although this may seem excessive, pharmacists and student pharmacists do a thorough job to create a patient-centered opioid exit plan. For example, they perform a medication reconciliation, and consult the prescription data monitoring program during admission, and then they round with the medical team to assess and discuss how to manage the patient’s pain. They, then customize their patient’s opioid regimen depending on whether he or she is opioid-naive or tolerant. Lastly, post- operation, the pharmacists and student pharmacists take their patients’ pain medications (inpatient) into consideration for their OEP and follow-up. Upon prescribing an opioid, the physician can consult the pharmacist regarding which opioid, dosage strength, and duration may be best, since the pharmacist collected information specific to the patient. By the time the patient is discharged, the pharmacist and prescriber would have created an opioid tapering plan, scheduled a follow-up appointment, medication evaluation, ,and properly counseled the patient regarding his or her opioid medication use. By using a pharmacist led OEP, pharmacists and physicians can reduce overprescribing opioids and the risk for opioid abuse and misuse.

The integration of pharmacists and pharmacy students in the workplace may reduce iatrogenic opioid misuse. While this can come in the form of supplementing the physicians’ counseling, pharmacists and pharmacy students are capable of much more. The Center for Disease Control recognizes that pharmacists are on the front lines of the opioid crisis, and they should partner with prescribers to be part of the team.. In the pain management team, pharmacists can reduce overprescribing and optimize the patient’s therapeutic options. Their expertise in medication allows them to work together with prescribers to determine the most appropriate therapy to enhance safety and efficacy based on patient-specific factors. To address the opioid crisis appropriately, the pharmacist’s role should be expanded because collaboration may be the key to solving the Opioid Epidemic.

Categories:  Substance Use Disorders InstituteDepartment of Health Policy and Public HealthDepartment of Pharmaceutical and Healthcare BusinessHealth PolicyMayes College of Healthcare Business and PolicyOpioidsPublic Health