Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts

Abstract

BackgroundAmid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. ObjectiveWe conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DesignWe invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. ParticipantsEighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated.

“I really had somebody in my corner.” Patient experiences with a pharmacist-led opioid tapering program

“…Similar to other studies, 8,12,31 many of the limitations reported by STORM program patients related to a need for additional resources to treat pain or tapering adverse effects. Nearly half of patients expressed frustration with nonpharmacological pain management suggestions provided by pharmacists; patients found these suggestions redundant to options they had already tried or unaffordable.…”

“…6,7 These guidelines necessitate providers initiating conversations about opioid tapering with patients and developing action plans. 8 However, these conversations can be challenging and time consuming for primary care providers (PCPs), and most PCPs lack sufficient training in managing the tapering process. PCPs have reported stress and burnout related to caring for patients requiring opioid tapers.…”

“…PCPs have reported stress and burnout related to caring for patients requiring opioid tapers. [8][9][10][11][12] Pharmacists can support both PCPs and patients with the process of opioid tapering, thus alleviating the burden on PCPs and increasing patient engagement. 10,11,13 However, little is known about the factors that determine patient acceptability and success with opioid tapering programs generally; even less is known about patient perspectives on programs led by pharmacists.…”

Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study

“…The pharmacist had the opportunity to review how patients were managing their analgesics and was able to provide recommendations to them on pharmacological and non-pharmacological strategies to improve overall pain management. Furthermore, the pharmacist was able to assess the patient’s understanding of the opioid management plan and provide education on the anticipated duration of opioid use, to minimize the risk of these medications inadvertently being prescribed for a prolonged period [ 19 ]. Numerous studies have demonstrated the benefits that patient education can have on reducing opioid use and improving pain and functional outcomes [ 6 , 20 , 21 ].…”

Potentially Inappropriate Drug Duplication in a Cohort of Older Adults with Dementia

“…Because multiple prescribers or multiple pharmacies may increase risk of drug duplication, a collaborative team approach headed by a single prescriber with ready access to pharmacist medication review and consultation is likely the best option to protect older adults with dementia from potential harms of drug duplication. 34 , 35 …”