Pharmacists Are the Answer to the Opioid Problem
Posted by: Gerald “Pharmacist Jerry” Finken, RPh, MS
The opioid epidemic could have been prevented if pharmacists had prescriptive and provider rights. I would also argue that this would solve the enormous problem we have in hand today. Crazy? I say not at all. Let’s consider.
One of the problems is over prescribing by those who CAN prescribe: doctors, nurse practitioners and, in some cases, physician assistants. I know of this first hand. On two different occasions, one after breaking some bones and two, after back surgery, I was prescribed and given at discharge from the hospital, 180 pills or a month’s worth of opioids. As I only had a few days of “breakthrough” pain, only a few days-worth would have been sufficient. Clearly, I had a lot left over. I have also heard similar stories from friends and family where they received far too many pills for their acute pain. In each of these examples, the counselling services of a pharmacist was missing.
So, here you are, with a surplus of opioids in your medicine chest. You don’t have ‘breakthrough’ pain anymore, but you are still not quite 100%. So, you keep taking the opioids and eventually, what was supposed to be temporary becomes habit. It wasn’t your intention, it just worked out that way. This is not uncommon. An article published by NPR on the opioid epidemic infers that most patients start out innocent about the addictive properties of the opioid pain medication and are not aware of the impact of their use when they change from acute use to chronic use, and usually unintentionally.
Narcotics, which include opioids, have been tightly controlled for decades to prevent the misuse. So, what changed to create this epidemic?
Many journalists and politicians point the finger at the pharmaceutical industry while others look at how the American Medical Association changed their view on pain management based upon the Joint Commission recommendation back in 2001. However, neither of these gets to what I believe is the root cause: the writing and dispensing of opioid prescriptions.
Again, doctors, nurse practitioners and, in some cases, physician assistants, are solely responsible for the writing of opioid prescriptions and as such, should be the ones to lead the way in ending the opioid crisis. Let’s take this one step further. The pharmacist could be enlisted to be the check and balance of the process as well as provide counselling services to ensure that the “five rights of medication administration” (the right patient, the right drug, the right does, the right time and the right route) are being followed. In most cases, this should prevent the misuse of opioids. To do this most effectively, though, the pharmacist would need to be given prescriber and prescriptive status.
This is not a far-fetched notion. Pharmacist are already making a positive difference being able to prescribe and dispense naloxone in many states. The APHA is also currently taking steps to address the opioid crisis by asking congress to pass the Pharmacy and Medically Underserved Areas Enhancement Act (S. 109/H.R. 592) which is a great first step towards getting to the root cause of the opioid crisis: not including the pharmacist in medication oversight process. Remember, pharmacists wear white coats too!
The opioid crisis and even the healthcare crisis would change immediately if pharmacists were given provider and prescriptive authorization. This would also mean that the government and the insurance industry would have to pay for ‘other’ pharmacist services rather than just dispensing services.
How would this work? An example: the doctor would call their local pharmacy to discuss the patient’s condition and the pain they have or may have. The doctor would authorize the pharmacist to prescribe what is necessary (including opioids) and rely on the pharmacist’s expertise to counsel and provide medication therapy management to treat the patient. This would allow the pharmacist—the medication expert—to determine the best course of medication for the patient including if opioids are even necessary. The pharmacist would then dispense only a few days-worth of medication if the patient is actually in pain and confirm with the patient the “five rights” as well as ensure the right quantity is given. The pharmacist would ask the patient to re-visit (or virtually visit) the pharmacy or pharmacist to see how their pain is being managed, noting the doctor is only a phone call way. This model would prevent the unknowing patient from becoming addicted which is now occurring all too frequently. Yes, it’s time to recognize the value of the pharmacist in solving the opioid crisis.
Do you agree?