Ethical dimensions of the prescription opioid abuse crisis

Stratton, Timothy P.; Palombi, L; Blue, Heather L; Schneiderhan, Mark E.

doi:10.2146/ajhp170704

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…One potential factor is the ethical dilemma pharmacists often face in weighing adequate pain relief against exposure to addictive opioid medications. 23 One participant in this study felt that “the pendulum has swung too far the other direction,” and expressed a reluctance to limit appropriate opioid access. This finding may also highlight a need for improved opioid- and pain-related education for pharmacists.…”

Section: Discussionmentioning

confidence: 94%

An Exploratory Study of Pharmacist Perceptions of Opioid Interventions for Acute Pain

Webb

Cernasev

et al. 2020

Journal of Pharmacy Technology

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Background: As the last health care provider encountered before an opioid is dispensed, pharmacists have a vital role in reducing unnecessary opioid exposure while facilitating access to non-opioid alternatives. Objective: To characterize pharmacist perceptions in providing interventions for patients with an opioid prescription for acute pain. Methods: This cross-sectional survey was administered over 3 months to pharmacy preceptors affiliated with the University of Tennessee Health Science Center College of Pharmacy. The electronic survey utilized 7 demographical and baseline questions, 1 open-ended question, and 5 Likert-type scales to assess the following domains: responsibility in making decisions, willingness to provide information, comfort in speaking to patients, willingness to use a standing order, and importance of following up with patients. Results: Of the 380 participants invited to participate, 126 responded to at least one question and 90 completed all survey questions. Most participants were PharmD graduates practicing in hospital and community settings. Participants felt that opioids are frequently overprescribed and pharmacist interventions are often necessary. Most participants reported that pharmacists and physicians share similar responsibilities in making opioid-related decisions. Participants were willing to provide information about opioid alternatives but were only somewhat comfortable speaking to patients. Responses to the open-ended question revealed the following themes: Significance of educating the patient; Importance of alternatives to opioid medications; Impacts of pharmacist interventions; and Need for enhanced collaboration with physicians. Conclusions: Pharmacists face complex issues with limited clinical guidance when providing opioid-related interventions. Future research is needed to develop evidence-based clinical support tools and collaborative practice models.

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Section: Discussionmentioning

confidence: 94%

An Exploratory Study of Pharmacist Perceptions of Opioid Interventions for Acute Pain

Webb

Cernasev

et al. 2020

Journal of Pharmacy Technology

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show abstract

“…To help more faculty gain proficiency in coaching students through ethical issues, faculty may avail themselves of the references cited earlier in this paper [13][14][15][16][17] and take advantage of educational opportunities offered through professional organizations including AACP 18 and others. 19 Examples of ethical dilemmas to discuss with students can come from faculty and students' personal experiences as health care provider or patient, as well as from textbooks, 9 current news stories, 4,5 or an Internet search using "pharmacy ethics cases" as a search term.…”

Section: Discussionmentioning

confidence: 99%

Incorporating Ethics Content Throughout an Integrated Pharmacy Curriculum

Stratton

2020

American Journal of Pharmaceutical Education

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Objective. To describe how Ethics content, formerly taught as a third-year stand-alone course, was incorporated into nine didactic courses across all three years, and into IPPEs and APPEs in a newly-integrated, two-campus PharmD curriculum at the University of Minnesota. Curriculum changes were intended to (1) provide students with opportunities to discuss and apply Ethics concepts several times throughout the curriculum, and (2) highlight Ethics topics relevant to material students were learning in the host course at the time. Methods. The free-standing one-credit required Ethics course from the old curriculum was eliminated. Partnering with Course Directors from nine required courses across all three years of the didactic curriculum and with the Office of Experiential Education, an Integrated Ethics syllabus was created that provided each class of approximately 170 students with at least one credit of didactic Ethics instruction and added Ethics activities to the experiential curriculum. Learning approaches include lecture, case analysis and discussions with preceptors. Assessment approaches include written case analysis, multiple-choice and true/false questions, case vignette-based short-answer essay questions, and student discussions with preceptors. Results. Students consistently rate the Ethics sessions as useful, but some students find repeated application of the ethics problem-solving framework tedious and repetitive. Conclusion.It is possible to embed Ethics topics within different courses as part of an integrated PharmD curriculum rather than offer a stand-alone Ethics course at a single time point in the curriculum. Students report appreciating this integration approach. Challenges remain to adequately assess student ability to apply Ethics principles.

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“…As Stratton et al note, one potential consequence of opioid prescribing that deserves ethical attention is "adequately addressing a patient's chronic noncancer pain without possibly setting the stage for addiction to opioid medications." 6 In this paper, we review the current state of ethical education and opioid-related courses in medical schools and describe strategies for improving training in the ethics of opioid prescribing. Learning from cases that encompass a broad spectrum of patient experiences and histories can better prepare students to identify potential issues such as misuse, diversion, and overdose while not negating the patient's needs.…”

mentioning

confidence: 99%

How Should Medical Education Better Prepare Physicians for Opioid Prescribing?

2019

AMA Journal of Ethics

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Opioid overprescribing is a key contributor to the current crisis. Changing how ethics is taught in connection with opioid prescribing is one area for improvement. In US medical schools, current training in ethics and opioid prescribing is variable, incorporating a diverse range of concepts, teaching modes, assessment strategies, and faculty experience. This article recommends integrating clinical case-based teaching and longitudinal application, comprehensive assessment, and additional training in ethical deliberation about opioid prescribing to better prepare physicians to responsibly prescribe and manage opioid-based phases of patients' pain care. Medical Education and Overprescribing In its current state, the opioid epidemic is a major public health issue that has garnered widespread attention. The National Institute on Drug Abuse reports that more than 130 people die every day as a result of opioid overdose. 1 Opioid overuse also poses a heavy financial burden on the nation, with the Centers for Disease Control and Prevention estimating that $78.5 billion is spent annually to respond to opioid misuse, addiction treatment, and related health care. 1

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Ethical dimensions of the prescription opioid abuse crisis

Cited by 8 publications

References 17 publications

An Exploratory Study of Pharmacist Perceptions of Opioid Interventions for Acute Pain

An Exploratory Study of Pharmacist Perceptions of Opioid Interventions for Acute Pain

Incorporating Ethics Content Throughout an Integrated Pharmacy Curriculum

How Should Medical Education Better Prepare Physicians for Opioid Prescribing?

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