The North American Opioid Experience and the Role of Community Pharmacy

Rosenberg‐Yunger, Zahava R. S.; Ellen, Moriah; Mickleborough, Tim

doi:10.1097/phh.0000000000000807

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…Pharmacists continue to have a role in reducing patient morbidity and mortality resulting from the opioid crisis ( Bratberg et al, 2020 ). Specifically, pharmacists provide harm reduction services including the provision of unused needles, administration of opioid substitution therapy, and education of patients regarding harm reduction (Z. R. S. Rosenberg-Yunger et al, 2018 ; Watson & Hughes, 2012 ). Our study discussed how Canadian pharmacists continued to provide harm reduction services during the pandemic and were able to utilize the exemption to prevent patients from seeking other drugs through the provision of a safe supply of opioids.…”

Section: Discussionmentioning

confidence: 99%

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Bishop

Rosenberg‐Yunger

2022

Drug and Alcohol Dependence

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Introduction During the COVID-19 pandemic, patients with opioid use disorder (OUD) struggled with access to prescribers and opioid agonist therapy (OAT). Recognizing this gap in care, Health Canada issued a short-term subsection 56(1) class exemption from the Controlled Drugs and Substances Act authorizing pharmacists to independently manage controlled substances. The purpose of this study was to explore the expanded role of Canadian pharmacists in providing care to patients with OUD during the pandemic. Methods We conducted qualitative key informant telephone interviews in the fall of 2020 with Canadian pharmacists who used the exemption. We included community or primary healthcare team-based pharmacists who managed opioid medication under the exemption. We recorded, transcribed verbatim, and de-identified all transcripts. Data was analyzed using a thematic approach involving line-by-line coding and constant comparison. Results We interviewed nineteen pharmacists with representation from all provinces and urban and rural practice settings. Three major themes emerged that captured the pharmacists’ perspectives when providing care for patients with OUD during the pandemic: (i) continuity of care; (ii) harm reduction; and (iii) access to care. Pharmacists used the exemption to extend prescriptions, transfer prescriptions, receive verbal orders, and deliver OAT. Conclusions Throughout the pandemic, pharmacists were able to provide continuity of care to patients with OUD who would have otherwise been unable to access care. The exemption permitted pharmacists to assess patients and provide OAT through this expanded role. Other countries should look to the Canadian experience and leverage the expertise of the pharmacist to expand their scope so that they can help fill the gap in care for patients with OUD.

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Section: Discussionmentioning

confidence: 99%

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Bishop

Rosenberg‐Yunger

2022

Drug and Alcohol Dependence

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“…[15] These findings align with results of a 2017 survey of Canadian pharmacies demonstrating naloxone availability in only 26.9% of Ontario pharmacies,[26] and suggests that barriers to pharmacy-dispensed naloxone continue to exist across the province. Low pharmacy participation could be related to pharmacists’ reluctance to stock or recommend naloxone due to perceived lack of demand,[26] stigma surrounding opioid-use disorder[27] or underestimation of overdose risk in prescription opioid recipients.…”

Section: Discussionmentioning

confidence: 99%

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

et al. 2019

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BackgroundNaloxone is a life-saving antidote for opioid overdoses. In June 2016, the Ontario government implemented the Ontario Naloxone Program for Pharmacies (ONPP) to enhance access to naloxone.ObjectiveWe examined the initial uptake of naloxone through the ONPP and characteristics of the individuals receiving and pharmacies dispensing naloxone kits.MethodsWe conducted a population-based study of all Ontario residents who received a naloxone kit between July 1, 2016 and March 31, 2018. This involved 1) a cross-sectional analysis of monthly rates of kits dispensed; and 2) a descriptive analysis of all individuals and pharmacies who accessed and dispensed naloxone, respectively. We stratified individuals according to their opioid exposure as: prescription opioid agonist therapy (OAT) recipients, prescription opioid recipients, those with past opioid exposure and those with no/unknown opioid exposure. We calculated a Lorenz curve comparing the cumulative percent of naloxone-dispensing pharmacies and cumulative percent of naloxone kits dispensed and the corresponding Gini coefficient.ResultsNaloxone dispensing through the ONPP increased considerably from 1.9 to 54.3 kits per 100,000 residents over the study period. In this time, 2,729 community pharmacies dispensed 91,069 kits to 67,910 unique individuals. Uptake was highest among prescription OAT recipients (40.7% of OAT recipients dispensed at least one kit), compared with 1.6% of prescription opioid recipients, 1.0% of those with past opioid exposure and 0.3% with no/unknown opioid exposure. Naloxone dispensing was highly clustered among pharmacies (Gini = 0.78), with 55.6% of Ontario pharmacies dispensing naloxone, and one-third (33.7%) of kits dispensed by the top 1.0% of naloxone-dispensing pharmacies.ConclusionThe ONPP launch led to a rapid increase in the number of naloxone kits dispensed in Ontario. Although the program successfully engaged people prescribed OAT, efforts to increase uptake among others at risk of opioid overdose appear warranted. Opportunities for expanding pharmacy participation should be identified and pursued.

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“…15 Pharmacists have demonstrated their role in addressing this crisis through various opioid stewardship activities, such as deprescribing, monitoring opioid use disorder, providing education and promoting harm-reduction strategies. 8,9,[16][17][18][19][20][21][22][23][24] With the exemptions, pharmacists are now better equipped to help address the opioid crisis by providing optimal care for patients who receive opioid medications. 25 To better understand the impact of the exemptions on pharmacists' ability to provide patient care, we set out to explore Canadian pharmacists' experiences with using the exemptions in practice.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmacists’ perceptions of the Canadian opioid regulatory exemptions on patient care and opioid stewardship

2021

Self Cite

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Background: This study explored the perceptions of Canadian pharmacists about the barriers and facilitators of providing opioid stewardship activities in pharmacy practice, considering the subsection 56(1) class exemption under Health Canada’s Controlled Drugs and Substances Act (CDSA). Methods: Qualitative key informant telephone interviews were conducted with a convenience sample of pharmacists from across Canada. We included community or primary health care team-based pharmacists who self-identified as having experience with providing care for patients using opioids via the exemptions. All transcripts were de-identified, and thematic analysis was conducted to identify themes. Ethics approval was obtained. Results: Twenty pharmacists from community and primary health care teams, from all provinces and from urban and rural practices were interviewed. The following themes emerged: 1) optimization of opioid-related patient care, 2) jurisdictional impact and 3) awareness and education. Barriers and facilitators for opioid stewardship activities were identified. Discussion: The exemptions facilitated the pharmacists’ ability to provide opioid stewardship and positively affect patient care by providing continuity of and timely access to care. Our research demonstrated that pharmacists can responsibly and independently manage opioid prescriptions within this expanded scope, demonstrating the valuable contribution pharmacists can have in opioid stewardship. Conclusion: Pharmacists were willing and able to care for patients receiving opioid medication and thereby played a role in helping address the opioid crisis. The benefits of these exemptions were demonstrated beyond situations related to the COVID-19 pandemic and warrant consideration for consistent implementation across provincial and territorial jurisdictions, thereby ensuring equitable access to care for all Canadians.

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The North American Opioid Experience and the Role of Community Pharmacy

Cited by 7 publications

References 13 publications

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

Pharmacists expanded role in providing care for opioid use disorder during COVID-19: A qualitative study exploring pharmacists’ experiences

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

Pharmacists’ perceptions of the Canadian opioid regulatory exemptions on patient care and opioid stewardship

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