A community pharmacy-led intervention for opioid medication misuse: A small-scale randomized clinical trial

Cochran, Gerald; Chen, Qi; Field, Craig A.; Seybert, Amy L.; Hruschak, Valerie; Jaber, Amanda; Gordon, Adam J.; Tarter, Ralph E.

doi:10.1016/j.drugalcdep.2019.107570

Cited by 30 publications

(64 citation statements)

References 44 publications

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“…50 Results of this study showed intervention feasibility, acceptability and significant improvements for patients compared to controls for opioid medication misuse, depression, and pain. 50 A second phase of this line of research will implement the intervention in a powered trial within a small system of community pharmacies. This program of research has begun to demonstrate pharmacists can successfully lead in the management of patients with opioid-related risk behaviors.…”

Section: Researchmentioning

confidence: 74%

Medication Treatment for Opioid use Disorder and Community Pharmacy: Expanding Care during a National Epidemic and Global Pandemic

et al. 2020

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Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are effective strategies for treatment of opioid use disorder (OUD) and reducing overdose risk. MOUD treatment rates continue to be low across the US, and currently, some evidence suggests access to evidence-based treatment is becoming increasingly difficult for those with OUD as a result of the 2019 novel corona virus (COVID-19). A major underutilized source to address these serious challenges in the US is community pharmacy given the specialized training of pharmacists, high levels of consumer trust, and general availability for accessing these service settings. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD over the past decades. Unfortunately, US pharmacists are not permitted to prescribe MOUD and are only currently allowed to dispense methadone for the treatment of pain, not OUD. US policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based through research, education, practice, and industry. Advancing community pharmacy-based MOUD for leading clinical management of OUD and dispensation of treatment medications will afford the US a critical innovation for addressing the opioid epidemic, fallout from COVID-19, and getting individuals the care they need.

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Section: Researchmentioning

confidence: 74%

Medication Treatment for Opioid use Disorder and Community Pharmacy: Expanding Care during a National Epidemic and Global Pandemic

et al. 2020

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“…general or family medicine practice and primary care clinics, 37-39,41-46, 49,51-60,65,66,68-76,83,84 healthcare organisations with a range of primary care settings, 47,48,[61][62][63][64]67,79 community pharmacy practices 77,78,85 and outreach services. 50,[80][81][82]86,87 The primary care settings, countries of origin and context of the studies are detailed in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…49,65,66,84 One study only investigated opioid specifically for acute pain and that was in a free dental clinic where the outcome was the change in rates of opioid prescribing. 73 Other quantitative outcomes were retention rates in pharmacist programs, 39,68,70 discontinuation of regular opioids, 77 initiation of pharmacist care plans, 40,51 procurement of take-home naloxone, 38,39,43,50,55,81 change of long-acting opioid formulation, 67 effect on overdose occurrence or premature deaths 39,62 and emergency department presentations. 55 For medical and nurse prescriber participants, the outcomes were any impact as assessed by acceptance rates of pharmacist or multidisciplinary committee recommendations 37,40,42,47,54,59,60,63,67,72,75,78,80,85 as well as measures of prescriber behaviour change, such as adherence to pain management protocols, initiation of nonopioids, prescriptions for take-home naloxone, referrals to external providers, reduced concomitant prescribing with benzodiazepines, engagement of patients in prescriber-patient opioid agreements, prescription monitoring, urine toxicology screening and other measures to assess patient aberrant behaviours, 37,38,40,41,…”

Section: Resultsmentioning

confidence: 99%

“…• Pharmacist-led medication review 42 • Pharmacist-led interprofessional nonmalignant pain management service 47 • Identification of risk via electronic records and communication to prescribers in team 37,53 or via fascimile 80 • Review by pharmacist-independent prescribers after identification by risk-assessment tool and GP referral 83 • Risk assessment in outpatient palliative care radiotherapy clinic 65 • Developed and implemented protocols and recommendations for cardiac monitoring of high-risk patients receiving methadone 37,46 • Managed patients under collaborative care models and drug therapy management protocols 45,69 • Developed and implemented programs to identify at-risk patients and to improve THN prescribing, 38,39,41,43,44,62 including calculation of overdose risk scores 39 • Interdisciplinary controlled substance committee recommendations 61 • Intensive intervention of outpatients identified with prescription opioid misuse 77 • Communicated to prescribers of risky combinations after review of electronic records 80 • Outreach education via telephone to patients identified as at risk by algorithm assessment of records 81 (Continues) 61,62,67,71,74,75,[77][78][79][80]85 Activities to reduce harm included targeting the opioid load and sedative combinations, increasing uptake of takehome naloxone supply, assessing potential risks of opioids, either of use disorder or for adverse effects, enabling opioid agreements, urine screening and prescription monitoring programs, and improving access to treatments. In many studies, pharmacists were actively involved in patient management and received direct referrals or prescribed independently.…”

Section: Focus Of Activity Description Of Pharmacist Activitymentioning

confidence: 99%

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Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities

Jordan

Latif

Mullan

et al. 2021

Brit J Clinical Pharma

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To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.

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“…27 Using the brief intervention approach for substance misuse in community pharmacies increased the feasibility and patients' acceptability to therapy management. 28 In addition, using community pharmacies for substance misuse interventions and harm reduction could have great potential, 29 especially in rural areas where health care is limited. 30 Although pharmacists' involvement in caring for people with SUD can be quite positive, 31,32 a broad array of measurements and skills are needed to advance community pharmacists' involvement, such as education, training, proper remuneration, guiding tools, and blueprints.…”

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confidence: 99%

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure

Fatani¹,

Bakke²,

Halpape³

et al. 2022

Journal of the American Pharmacists Association

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Background: Pharmacists' roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists' care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere. Objectives: The aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances. Methods: A focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit. Results: Two rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit. Conclusion: A Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.

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A community pharmacy-led intervention for opioid medication misuse: A small-scale randomized clinical trial

Cited by 30 publications

References 44 publications

Medication Treatment for Opioid use Disorder and Community Pharmacy: Expanding Care during a National Epidemic and Global Pandemic

Medication Treatment for Opioid use Disorder and Community Pharmacy: Expanding Care during a National Epidemic and Global Pandemic

Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities

Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure

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