Opioid use has increased along with the rising number of Americans reporting chronic pain in recent years.
Collaboration between physicians, patients, and pharmacists is essential for addressing the public health crisis of opioid misuse and overdose in the United States, according to a presentation at the ASHP Midyear 2016 Clinical Meeting and Exhibition.1
Christopher M. Jones, PharmD, MPH, who is director of the Division of Science Policy at the US Public Health Service, discussed the opioid crisis at the meeting.
Dr. Jones noted that just as the number of Americans reporting chronic pain has climbed in recent years, so too has opioid use, totaling some $78.5 billion per year.2 Misuse of both prescription opioids and illegal drugs like heroin has also become more common. Data also indicate that nonmedical use of prescription opioids is a significant risk factor for heroin use.3
Dr. Jones cited an outbreak of HIV in Indiana and increases in hepatitis C infection in Kentucky, Tennessee, Virginia, and West Virginia that were both related to injection drug use as examples of additional health care issues that have grown from the opioid crisis.
In an effort to address the problems associated with opioid misuse, federal health officials introduced the Opioid Initiative in 2015, which was designed to improve opioid prescribing measures, expand use of medication-assisted treatment for opioid use disorders, and increase use and access to naloxone to reverse opioid overdoses.
Just last March, federal health officials launched the National Pain Strategy, which focused on prevention, professional education and training, and educating the public about opioids.
The key to educating the public and helping to get all parties on the same page is first identifying the different attitudes among physicians, pharmacists, and patients about prescription opioid use, Dr. Jones explained. He cited a study by Hwang et al4 that noted that more than half of a group of surveyed primary care physicians considered drug abuse in the community to be a “big problem,” and almost half of those surveyed “strongly or somewhat agreed” that opioids are “overused for pain.”
The problem, Dr. Jones said, is that the patient expectations are often very different from the physicians, with many engaging in behaviors that are associated with overdose (taking older pills, etc) and many not being equipped to properly use naloxone in the event of an overdose in the home.
Addressing the dangers involved in these practices with patients is key, Dr. Jones said, and pharmacists are in a good position to have these discussions with patients. Staying on top of electronic medical record medication histories, as well as helping to collect pain assessments and using reports to identify actionable patients are good places for the pharmacist to start in determining which patients may be at risk for opioid misuse.
As evidence of how strong the pharmacists’ role can be in helping to reduce opioid overuse, Dr. Jones pointed to a pharmacist-led initiative in a large VA primary care clinic that involved 5 primary care physicians and their patients. Risk assessment and treatment recommendations were implemented by the pharmacists, with pharmacists recommending 66 changes to chronic opioid therapy in about 33% of the patients, including decreased opioid quantity or delays of fills. Ninety-two percent of the recommendations were implemented by the providers, demonstrating there were areas to improve current practice.
1. Jones CM. Federal forum keynote: The pain & opioid crisis — a call to action for the pharmacy profession. Presented at: ASHP Midyear 2016 Clinical Meeting and Exhibition. Dec. 3-8, 2016. Las Vegas.
2. Florence CS, Zhou C, Luo F, Xu L. Med Care. 2016;54(10):901-906.
3. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers — United States 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013.
4. Hwang CS, Turner LW, Kruszewski SP, et al. Prescription drug abuse: a national survey of primary care physicians. JAMA. 2015;175(2):302-304.