I can’t help but think that everyone should make an effort to listen to the pharmacists’ voices about the opioid crisis.  But the news that came out recently about pharmacists feeding the opioid crisis was appalling and extremely disturbing.  That’s not what I had in mind when I want to share my reflection on the opioid crisis.

Perhaps that’s just a small percentage of individuals who may do harm no matter how we label them in society – doctors, lawyers, police officers. There will be good ones and there will be not so good ones.  But as pharmacists, we are the legal gatekeepers of opioids and we must remember that this comes with a special responsibility to safeguard  the opioids from falling into the wrong hands.

And here comes my real reflection of the opioid crisis – pharmacists are not equipped with the resources to address the crisis effectively.

As a pharmacist, I have encountered patients on opioid prescriptions from different backgrounds.  I have dealt with prescription forgery, intervened with prescriptions that do not meet legal requirements, and have dealt with patients frustrated when their prescriptions could not be dispensed due to a variety of reasons. I have observed aberrant behaviours as well as tearful encounters with patients when discussing their opioid prescriptions. These situations would often be filled with anxiety and possibly fear.  They are never easy for pharmacists.

I also see a variety of prescribing patterns and behaviours in the community.  I often see dentists prescribing Percocet when I think Tylenol #3 may offer similar pain relief but with less addictive potential. I have seen prescriptions from emergency physicians prescribing a large quantity of opioids when I would question if a smaller quantity may be sufficient for the acute pain. I have dealt with a nurse ordering morphine infusion pump for the palliative patient, only to realize the patient has passed away weeks ago which prompted a call to the College of Nursing and a police investigation. I also see a vulnerable side from prescribers too, that sometimes they want to discuss tapering or deprescribing the opioids but may be fearful how the interaction may turn ugly at times.

The opioid crisis affects everyone in our community. As pharmacists, we are at the centre of it.  

But I also think we do not always have all the tools to help address the opioid crisis. It takes a lot of effort, a lot of discussion and a lot of coaching and support and not every pharmacist, patient or prescriber is ready to take on this journey that may be confronted with heavy emotional toll, unpredictability and many obstacles and challenges.

Many recent efforts within the pharmacy community have focused on ensuring we have a controlled system to distribute Fentanyl patches to prevent diversion (e.g.  the Patch 4 Patch program). We also have a system to distribute Naloxone kits and educate the public on how to administer them in case of opioid overdose. And there is also an increased effort to focus on training clinicians on how to prescribe opioid substitution therapy.

But I also feel we need more rethinking on how community pharmacists or primary care pharmacists can collaborate with prescribers on offering meaningful discussion and monitoring of patients on opioids. These include developing initiative to help patients understand the risks of high dose opioids and collaborating with prescribers to support best practices for opioid prescribing.  Pharmacists can help prescribers to develop a tapering plan of opioids or opioid rotation if indicated. It is also prudent to share relevant updates or warning signs of potential opioid use disorder, offer support for withdrawal symptoms management as well as connecting with relevant addiction and mental health support as needed.

Personally, I will admit that it isn’t always easy to intervene for a questionable opioid prescription when working as a community pharmacist. If an opioid prescription is prescribed by an emergency physician, it may be difficult to track down the same physician for clarification in a timely manner. At any given time, the community pharmacist may have many medications questions to address, medications to be dispensed and many prescriptions problems to resolve.

There is no dedicated time to address issues as complex as the opioid crisis, even if a pharmacist may be confronted with it in the community. 

Yet we are at the centre of the opioid crisis, sometimes unable to address the issue assertively as we observe how all the stakeholders are affected by it. I wholeheartedly feel that the opioid crisis is complex and must be tackled with compassion and perseverance. I believe our entire system need to be better integrated with prescribers to address the opioid crisis and pharmacists offer a unique perspective and can be helpful to contribute to an effective solution.  

But highlighting one bad apple isn’t going to help bring forth a solution. Let’s shift the focus to collaboration instead.

Thank you for reading my post.