Beth Lofgren, PharmD, BCPS
Beth Lofgren, PharmD, BCPS, received her PharmD degree from the University of Tennessee at Memphis in 1999, after completing a BS at the University of Tennessee at Martin. She started her pharmacy career in retail and has practiced in home health, long-term care, and hospital pharmacy. She has also been blogging as the Blonde Pharmacist since 2004, focusing on education for peers and provider status for pharmacists.
In the health care field, it’s not uncommon to know someone who has or will become addicted to opioids. I have personally seen friends and colleagues either illegally sell these medications or become addicted to them, both of which are very destructive.
Needless to say, pharmacists need to get involved in this growing problem.
We see patients being treated for opioid addiction with buprenorphine, a partial mu-opioid receptor agonist, and methadone. We also see patients coming in for routine surgeries and being placed on multiple pain medications with no real assessment of whether they have a propensity toward opiate addiction or whether the surgery itself will spiral them back into the addiction they once overcame.
In reposonse to the drug abuse crisis, the US Centers for Disease Control and Prevention has released guidelines on pain medication prescribing that include the following:
- In the cases of pain that don’t involve cancer, end-of-life care, or palliative care, use non-opioid medications.
- If you must use opioids, use the lowest dose.
- Monitor the patient at all times.
There was a time in my life when I was trying to find relief for low back pain that plagued me from my running days. I was heavier and had given birth to 2 children, and I felt like the pain was unrelenting. Ibuprofen and naproxen no longer helped, and I was desperate.
You kind of know if you have a propensity toward opioids, and I personally wanted to avoid them if at all possible. I ended up trying physical therapy and begged for back surgery, but I slowed down when a neurosurgeon said he would not operate on me and that I would be a fool to find someone who would.
I listened and started working on weight reduction and another alternative (radiofrequency lesioning) that bought me time to reduce facet joint lower back pain and increase my core strength. I’m happy to say it worked, but I know others who went the surgery route and their pain only worsened.
Others causes of pain that aren’t mechanical include autoimmune disorders and neurological pain. In every single case, pain must be evaluated and treated at the lowest possible dose, and side effects must be monitored.
Gastroparesis can happen. Oversedation and overmedication can cause death. Addiction can cause a patient to seek illegal pathways to find what they’re craving to feel normal.
How can pharmacists help? First and foremost, we can manage a patient’s pain medications.
Pharmacists are able to help with selecting the best possible pain medication for the level of pain that a patient is experiencing. We understand how other medications like docusate can help alleviate some side effects that can be very troublesome.
We need to do more to help patients taking opioids, because we know more about these medications than anyone else on the health care team.