Pharmacists on the front-line of solving a public health crisis: Increasing access to medications for opioid use disorder

Luli, Alex J.; Bounthavong, Mark; Watanabe, Jonathan H.

doi:10.1016/j.japh.2019.10.014

Cited by 6 publications

(6 citation statements)

References 31 publications

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“…The long-lasting opioid-involved overdose death epidemic and shortages of MOUD capability in the US indicate a clear need to implement pharmacy-based treatments for opioid use disorder (PADMOUD) to improve access to, and retention in, methadone treatment [ 8 , 31 ]. PADMOUD in the US has been underutilized and understudied.…”

Section: Discussionmentioning

confidence: 99%

Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff

Wu,

Mannelli,

John

et al. 2023

Subst Abuse Treat Prev Policy

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Background The US federal regulations allow pharmacy administration and dispensing of methadone for opioid use disorder (PADMOUD) to increase the capability of opioid treatment programs (OTPs) in providing methadone maintenance treatment (MMT) for opioid use disorder (OUD) as part of a medication unit. However, there is a lack of research data from both pharmacy and OTP staff to inform the implementation of PADMOUD. Methods Staff of a pharmacy (n = 8) and an OTP (n = 9) that participated in the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were recruited to participate in this qualitative interview study to explore implementation-related factors for PADMOUD. Each interview was recorded and transcribed verbatim. NVivo was used to help identify themes of qualitative interview data. The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to guide the coding and interpretation of data. Results Six pharmacy staff and eight OTP staff (n = 14) completed the interview. Results based on PARIHS domains were summarized, including evidence, context, and facilitation domains. Participants perceived benefits of PADMOUD for patients, pharmacies, OTPs, and payers. PADMOUD was considered to increase access for stable patients, provide additional patient service opportunities and revenues for pharmacies/pharmacists, enhance the capability of OTPs to treat more new patients, and reduce patients’ cost when receiving medication at a pharmacy relative to an OTP. Both pharmacy and OTP staff were perceived to be supportive of the implementation of PADMOUD. Pharmacy staff/pharmacists were perceived to need proper training on addiction and methadone as well as a protocol of PADMOUD to conduct PADMOUD. Facilitators include having thought leaders to guide the operation, a certification program to ensure proper training of pharmacy staff/pharmacist, having updated pharmacy service software or technology to streamline the workflow of delivering PADMOUD and inventory management, and reimbursement for pharmacists. Conclusion This study presents the first findings on perspectives of PADMOUD from both staff of a community pharmacy and an OTP in the US. Finding on barriers and facilitators are useful data to guide the development of strategies to implement PADMOUD to help address the US opioid crisis.

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Section: Discussionmentioning

confidence: 99%

Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff

Wu,

Mannelli,

John

et al. 2023

Subst Abuse Treat Prev Policy

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Although the literature regarding opioid-related partnerships in the community setting is limited, future research could be informed by studies of collaborative practice models for other disease states (eg, hypertension, diabetes, HIV). 29 A novel finding of this study is related to the lack of consensus among pharmacists regarding appropriate opioid alternatives for acute pain. Although many participants commented on the importance of nonopioid treatment options, there was a large degree of variability among the responses.…”

Section: Discussionmentioning

confidence: 99%

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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“…71,131 Buprenorphine is also pre- nance OUD therapy. 71,131,153 Although the majority of OUD treatment occurs in outpatient settings, 126 These barriers must be addressed by medical and regulatory agencies.…”

Section: Medication-first Treatment Approachmentioning

confidence: 99%

“…This type of collaborative approach to OUD is associated with positive patient perceptions about treatment 152 and can help generate more X‐waivered providers as well as increase training opportunities for all types of health care providers in SUD. Community pharmacies could serve as either hubs or spokes, by referring patients to specialized, intensive, and comprehensive addiction care services after induction, or closely monitoring and adjusting maintenance OUD therapy 71,131,153 …”

Section: Oud Treatmentmentioning

confidence: 99%

Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy

Coon

Hill

Hutchison³

et al. 2020

J Am Coll Clin Pharm

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The opioid crisis represents one of the largest failures of our current health care system as it continues to claim lives at an unprecedented rate and has caused a devastating range of preventable morbidity. Although the availability of highly potent synthetic opioids has amplified the urgency of the crisis for patients and communities, this problem has evolved over several decades. Pharmacists are in a position to offer many potential solutions due to their widespread accessibility, extensive drug knowledge, and integration into various health care settings. This opinion paper challenges the status quo by calling on all pharmacists to embrace evidence‐based opioid stewardship and harm reduction practices, contribute to the medical management of opioid use disorder, and address the misconceptions and prejudices that serve as barriers to effective, compassionate patient care. Regardless of practice setting or available resources, pharmacists can take deliberate and impactful steps to address the opioid crisis. Some pharmacists may be positioned to implement innovative and far‐reaching pharmacist‐led clinical services, while others may simply begin with careful consideration of the language they use when speaking to and about patients with substance use disorders. To optimize patient outcomes, the ineffective laws, regulations, and policies that negatively impact pain and addiction care must be addressed so that evidence‐based solutions can be widely disseminated. Pharmacists must aggressively advocate for the removal of barriers preventing high‐level clinical practice or policies that perpetuate patient harm and abandonment. Finally, there must be support for continued research on pain and opioid use disorder treatments and services, as well as the impacts of harm reduction practices and pharmacist‐led clinical services, so that resources can be allocated effectively.

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Pharmacists on the front-line of solving a public health crisis: Increasing access to medications for opioid use disorder

Cited by 6 publications

References 31 publications

Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff

Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff

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

Mobilizing pharmacists to address the opioid crisis: A joint opinion of the ambulatory care and adult medicine practice and research networks of the American College of Clinical Pharmacy

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