As we continue to hear the impact of the opioid crisis in our communities across Canada, I wonder how pharmacists have positioned themselves in the communities to help address the concern.  

One successful initiative is the Fentanyl Patch4patch program in Ontario. It was first initiated by local pharmacies to minimize the risk of Fentanyl patch diversion by asking patients to return used Fentanyl patches before additional patches can be dispensed. Given its rate of success, the program has now been extended throughout the province of Ontario as a mandatory requirement before refilling any Fentanyl Patch prescriptions.

Another new initiative is the distribution of the naloxone kit – a life saving antidote to opioid overdose. The naloxone kits are now readily available in the pharmacy to the public at no cost. As such, the pharmacists are also in the position to provide appropriate education to the public on how to identify opioid overdose and on how to give naloxone in an emergency situation.

But are there more we can do?

Based on the 2017 Canadian Guideline for Chronic Pain, here are some ideas that have come across my mind:

  • Offer Pain Education to the Public
    • It may be second nature to health care professionals about the various types of pain. But the public may not be aware of the various types of pain and how treatment options may differ depending on the pain type (acute pain, chronic non-cancer pain, cancer and palliative pain, neuropathic pain). It is important to discuss about goals of therapy or expectations of analgesics. For example, sometimes complete pain relief may not be realistic, whereas a reduction in pain to help with daily activities of living may be more achievable.  It is important to set the right expectation to minimize over-consumption of opioid analgesics.
  • Ensure non-opioid options are offered and optimized as appropriate
    • When a patient presents with a prescription for opioid (especially from a recent visit to the Emergency department), it is important to assess and consider if the patient has tried and optimized other non-opioid options. This could be in the form of increasing the dose of oral acetaminophen (especially for osteoarthritis), adding temporarily a short course of NSAIDS (especially for acute pain from injuries) and offering a topical NSAIDs preparation (for mild to moderate pain).  Non-drug measures should be explored as well.  The pharmacist can recommend some over-the-counter options and provide proper administration instructions where appropriate (e.g. discuss the usual dose, frequency of use as well as maximum daily limit, recommend to take NSAIDs with food to avoid gastric ulcers, recommend frequent application with topical analgesics)

 

  • Assess the Opioid Addiction Risk
    • Sometimes it is difficult to know if an individual may be at risk of opioid addiction in the community. However, there is a quick and simple tool that can be utilized to assess this risk. Click here to access an online version.  The tool is designed such that a score can be determined based on various factors including history of substance use disorder and other psychiatric conditions. The tool can be used as a decision aid for additional interventions. For example, an individual who has scored moderate to high risk for opioid addiction may require more frequent monitoring and dispensing of smaller quantity of opioids to manage the risk.

ORT

 

  • Identify local resources for referral and to share with patients
    • Often pharmacists are the primary care providers for the public. It is important to be aware of local resources so that at-risk patients may be referred timely to receive the appropriate care.  Examples of local resources include:
      • Cognitive behavior therapy & other psychotherapies
      • Pain specialist
      • Physicians with special interest in pain and addiction
      • Physicians trained to prescribe Suboxone or Methadone

 

  • Remind patients to return unused opioid medications to pharmacy for proper disposal. Not only should medications never be flushed down the drain or toilet, they should not be kept in the bathroom or kitchen cupboard if they are no longer needed, especially when the household may have children who may eventually become curious about taking them for recreational use.

Finally, it is our job to help patients understand whether their analgesics including opioids are effective or not. We can help them identify specific parameters that can be measured or quantified.  understand the limitations of opioids as well as other analgesic options. We can also identify opportunities where opioids may be tapered off or rotated and address with the prescribers where appropriate.

When pharmacists work collaboratively with prescribers and full engaged patients,   we can all make a contribution to addressing the opioid crisis in our communities.  Do you have any ideas how pharmacists can contribute during the opioid crisis? I would love to hear from you.  Thank you for reading my post.

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