Clinical pharmacists are not only on the front lines of health care, but also the battle against the ongoing opioid epidemic in the United States.

Pharmacy-based opioid clinics are just 1 way these accessible health care providers can serve their communities. At the American Society of Health-System Pharmacists (ASHP) Summer Meeting in Boston, Veterans Affairs (VA) pharmacy professionals discussed clinics that are making an impact in Florida and Minnesota, and how similar programs can be implemented.

The session “On the Front Lines of Safety: Implementing a Pharmacy-Based Opioid Clinic”  was presented by Norman G. Hooten, Pharm D, (Ret.) US Army Master Sergeant and clinical pharmacy specialist, mental health at Orlando VA Medical Center; and Terri Jorgenson, RPh, BCPS, National Program Manager, VA Pharmacy Benefits Management, and Clinical Pharmacy Practice Office.

According to Hooten, 51% percent of individuals living with substance use disorders (SUDs) also have a mental health disorder, and chronic pain is estimated to double the risk of death by suicide. Veterans are twice as likely to die from opioid overdose than other patients.

Pharmacists are part of collaborative care models for opioid use disorder (OUD) treatment and suicide prevention. Studies have shown that integrating pharmacists in OUD collaborative care models improves access to treatment and retention for patients. Pharmacists offer stewardship for pain management and opioids, improve opioid safety and prescribing, and help to manage costs.

According to Jorgenson, pharmacist providers in a OUD MAT collaborative care model may be tasked with MAT induction stabilization and maintenance, naltrexone prescriptions, risk mitigation and education, comorbidity care and referral, and assessing suicide risk.

She said the VA employees 9000 clinical pharmacists, of which 46% have a Scope of Practice, and 81% have a residency or certification.

At a Minneapolis VA Health Care System clinic, pharmacist primary care providers are tasked with pain management and opioid risk mitigation as standard practice.

As integrated providers, pharmacists have improved access to pain, mental health, and SUD care with shorter wait times and, often, same day access, which results in higher patient satisfaction, according to Jorgenson. For OUD and SUDs, pharmacists have increased identification of patients in need of treatment, improved MAT retention, and are monitoring and managing withdrawal symptoms.

Hooten said he studied pharmacy following a military career, during which he witnessed soldiers struggling with SUDs and mental health issues. As a pharmacy resident, he began working in a clinic and saw a need for service as a health care provider.

According to Hooten, he was able to build a “big picture” of a patient by following their ongoing health issues and could provide pharmacist intervention. “I was seeing a patient with SUD, and 2 months later I’d see the same guy with SUD,” he said.

In March 2018, the West Palm Beach (WPB) VA Medical Clinic (VAMC) opened its CARA (Comprehensive Addiction and Recovery Act) Clinic. Signed in 2016 by President Obama, CARA expanded addiction treatment services and overdose reversal medications.

The WPB VAMC offers an interdisciplinary staff that accepts referrals from primary care providers for chronic pain and SUDs with an OUD focus. In the clinic, pharmacists work with mental health and pain service professionals, including psychiatrists and physicians, as well as psychologists and suicide prevention specialists.

To establish a pharmacist-led OUD clinic, Jorgenson said these strategies are key:
  • Establish the issues and opportunities for pharmacists in providing the service
  • Identify the key stakeholders
  • Identify the pharmacist scope, including clearly defined roles and practice areas
  • Define care coordination, including appropriate referrals
  • Establish space and care delivery, such as scheduling, equipment, etc.
  • Identify ancillary support needs that lead to delivery of the same health care experience to every patient
  • Build the team
Opportunities to assist patients with OUD also are available to pharmacy technicians. These professionals can, for example, handle calls to patients to provide information and reminders; and participate in patient appointments by taking medication histories and documenting pill counts, among other tasks. Pharmacy technicians also are front line professionals that can identify patients that might need intervention for OUD or an appointment with a pharmacist provider.


Reference

Hooten N, Jorgenson T. “On the Front Lines of Safety: Implementing a Pharmacy-Based Opioid Clinic”. Presented at American Society of Health-System Pharmacists (ASHP) Summer Meeting, June 10, 2019. Accessed June 12, 2019.