Leveraging the PDMP to Expand the Pharmacist’s Role in Caring for Patients with Opioid Use Disorder
Written by Anna Haley PharmD’ 22
Published on October 4, 2021
Imagine you are a pharmacist and a new patient presents a prescription for a large quantity of oxycodone 20mg for a 15-day supply. You check the prescription drug monitoring program (PDMP) because they’re a new patient and it shows they filled a similar prescription only 10 days ago at a different pharmacy by a different out of state doctor. As the pharmacist, what would you do? Could the patient potentially be misusing the medication? Could they have uncontrolled pain? Is something else going on? Do you tell the patient you cannot dispense the prescription, or would you take a different approach? In my previous blog “PDMP: Friend or Foe for Pharmacists and Patients During the Opioid Crisis?”,Idiscussed some of the consequences patients may experience if unable to receive their medication at a pharmacy, including withdrawal, illicit drug use, or overdose. This blog goes beyond these consequences and will address how pharmacists can better utilize the PDMP to play a larger role in treating substance use disorders (SUD).
The previous scenario is one that many pharmacists have experienced throughout their career. Some of the typical steps pharmacists take in this scenario include calling the prescriber, calling the previous pharmacy, or denying the prescription. Unfortunately, many pharmacists will deny the prescription and not engage the patient regarding the potential concerns. There are several barriers’ pharmacists face when attempting to intervene on a patient, such as lack of education on PDMP utilization, fear of aggravating the patient, inadequate time, and lack of confidence. In recent years, there has been a national push to increase access to effective harm reduction strategies (e.g., statewide naloxone standing order protocols) and evidence based treatment (e.g., increase in buprenorphine prescribers), but little has been done to overcome pharmacy level barriers to these services. Unfortunately, a finite amount of progress can be made for improving access to evidence-based approaches for patients with opioid use disorder (OUD) without addressing these barriers.
Increasing pharmacist education and training on SUD treatment can have a large impact on the quality of patient care. Many pharmacists may not have been adequately trained on how to care for patients with OUD which then puts them in a difficult position between their legal responsibility as a pharmacist and their professional responsibility to the patient. Additionally, more pharmacists are utilizing the PDMP to make decisions on whether or not to dispense an opioid prescription; however, as Chiarello et al 2021 describes, PDMPs were developed as “enforcement technologies, not healthcare tools”. The PDMP can be utilized to identify patients who are potentially misusing their opioid prescriptions, but pharmacists need to be trained on the next steps. When pharmacists are not trained on conducting next steps for a patient, there becomes a disconnect in the patient’s care that may lead to potentially dangerous consequences for the patient. Once a patient has been identified through their PDMP record as potentially at risk for OUD, the pharmacist should conduct a screening and possibly a brief intervention, if needed. There are several programs that educate pharmacists about OUD, screening and brief intervention (e.g., Strand et al 2019), and how to better utilize the PDMP (e.g., Alley et al 2020,). After a pharmacist either identifies potential misuse through the PDMP or upon screening the patient, the next step might be referring the patient to treatment. As more programs are developed for pharmacists, there will be more opportunities for pharmacists to play a larger role in patient care.
Improvement of pharmacist and prescriber relationships is also essential for providing better care for patients with OUD. There are numerous examples where pharmacists work collaboratively with physicians in the care of patients with diabetes, hypertension, and hypercholesterolemia. Perhaps pharmacists and prescribers can enter into collaborative practice agreements in the care of patients with OUD. These types of collaborative practice agreements would empower the pharmacist to play an active role in the patient’s care and provide more continuity of care. So, why should OUD be any different?