PHARMACY'S ROLE IN ADDRESSING OPIOID CRISIS: STRATEGIES AND INTERVENTIONS
Main Article Content
Keywords
community pharmacy, prescription opioids, pain management, and opioid crisis
Abstract
Context: The opioid crisis presents a significant financial burden on the Saudi healthcare system and the persistent increase in opioid-related fatalities, both of which pose a grave threat topublic health in Saudi. Developing and implementing strategies to reduce the risk of opioid overdoses and other complications associated with the use of prescription opioids is essential. Moreover, as medication experts and one of the most approachable frontline healthcare professionals, chemists are well-positioned to provide effective opioid stewardship through a pain management programme that promotes the safe and appropriate use of opioids to reduce the risk of opioid misuse, abuse, and harm, supports appropriate prescription and dispensing of opioids, and facilitates appropriate prescription and dispensing. Implementing Methods: In order toascertain the components of an effective pain management programme based in a community pharmacy, including the necessary facilitators and barriers, an exhaustive review of the grey literature, PubMed, and Embase was conducted. A effective pain management programme shouldconsist of multiple components, prioritise the treatment of co-morbid disorders over pain, and incorporate a component for the continuing education of chemists. It is advisable to contemplate strategies for surmounting implementation challenges, including enhancing pharmacy productivity, confronting stigma, attitudes, and beliefs, addressing pharmacy compensation, and capitalising on the broader applicability of the Controlled Substances Act exemption to facilitate implementation. In order to underscore the impact that chemists can exert on chronic pain management and as a potential measure to combat the opioid crisis, forthcoming research should concentrate on the design, execution, and assessment of an evidence-based intervention strategy comprising multiple components within community chemist's in Saudi. Further investigation is warranted to compute the program's collateral expenses in addition to any potential cost savings for the healthcare system. Context: The opioid crisis presents a significant financial burden on the Saudi healthcare system and the persistent increase in opioid-related fatalities, both of which pose a grave threat to public health in Saudi. Developing and implementing strategies to reduce the risk of opioid overdoses and other complications associated with the use of prescription opioids is essential. Moreover, as medication experts and one of the most approachable frontline healthcare professionals, chemists are well-positioned to provide effective opioid stewardship through a pain management programme that promotes the safe and appropriate use of opioids to reduce the risk of opioid misuse, abuse, and harm, supports appropriate prescription and dispensing of opioids, and facilitates appropriate prescription and dispensing. Implementing Methods: In order to ascertain the components of an effective pain management programme based in a community pharmacy, including the necessary facilitators and barriers, an exhaustive review of the grey literature, PubMed, and Embase was conducted. A effective pain management programme should consist of multiple components, prioritise the treatment of co-morbid disorders over pain, and incorporate a component for the continuing education of chemists. It is advisable to contemplate strategies for surmounting implementation challenges, including enhancing pharmacy productivity, confronting stigma, attitudes, and beliefs, addressing pharmacy compensation, and capitalising on the broader applicability of the Controlled Substances Act exemption to facilitate implementation. In order to underscore the impact that chemists can exert on chronic pain management and as a potential measure to combat the opioid crisis, forthcoming research should concentrate on the design, execution, and assessment of an evidence-based intervention strategy comprising multiple components within community chemist's in Saudi. Further investigation is warranted to compute the program's collateral expenses in addition to any potential cost savings for the healthcare system.
Downloads
References
1. Public Health Agency of Canada. Modelling Opioid-Related Deaths during the COVID-19 Outbreak. Government of Canada. Updated 5 August 2022. Available online: https://www.canada.ca/en/health-canada/services/opioids/data-surveillance- research/modelling-opioid-overdose-deaths-covid-19.html (accessed on 12 October 2022). 2. Substance-Related Overdose and Mortality Surveillance Task Group (SOMS-TG) of the Special Advisory Committee (SAC) on the Epidemic of Opioid Overdoses—Public Health Agency of Canada. Apparent Opioid and Stimulant Toxicity Deaths: Surveillance of Opioid- and Stimulant-Related Harms in Canada January 2016 to March 2022. Government of Canada. Published September 2022. Available online: https://health-infobase.canada.ca/src/doc/SRHD/Update_Deaths_2022-09.pdf (accessed on 12 October 2022). 3. Substance-Related Overdose and Mortality Surveillance Task Group (SOMS-TG) of the Special Advisory Committee (SAC) on the Epidemic of Opioid Overdoses—Public Health Agency of Canada. Opioid and Stimulant Poisoning Hospitalizations: Surveillance of Opioid- and Stimulant-Related Harms in Canada January 2016 to March 2022. Government of Canada. Published September 2022. Available online: https://health-infobase.canada.ca/src/doc/SRHD/Update_Hospitalizations_2022-09.pdf (accessed on 12 October 2022). 4. Gondora, N.; Versteeg, S.G.; Carter, C.; Bishop, L.D.; Sproule, B.; Turcotte, D.; Halpape, K.; Beazely, M.A.; Dattani, S.; Kwong, M.; et al. The role of pharmacists in opioid stewardship: A scoping review. Res. Soc. Adm. Pharm. 2022, 18, 2714–2747. [PubMed] 5. Canadian Centre on Substance Use and Addiction. Canadian Drug Summary: Prescription Opioids. Published July 2020. Available online: https://www.ccsa.ca/sites/default/files/2020-07/CCSA-Canadian-Drug-Summary-Prescription-Opioids- 2020-en.pdf (accessed on 14 October 2022). 6. Canadian Substance Use Costs and Harms Scientific Working Group. Canadian Substance Use Costs and Harms (2015–2017). Canadian Centre on Substance Use and Addiction. Published 2020. Available online: https://csuch.ca/publications/CSUCH- Canadian-Substance-Use-Costs-Harms-Report-2020-en.pdf (accessed on 25 October 2022). 7. Institute for Safe Medication Practices Canada. Opioid Stewardship. Available online: https://www.ismp-canada.org/opioid_ stewardship/ (accessed on 22 September 2022). 8. Law, M.R.; Dijkstra, A.; Douillard, J.A.; Morgan, S.G. Geographic accessibility of community pharmacies in Ontario. Healthc. Policy 2011, 6, 36–46. [PubMed] 9. Murphy, L.; Ng, K.; Isaac, P.; Swidrovich, J.; Zhang, M.; Sproule, B.A. The Role of the Pharmacist in the Care of Patients with Chronic Pain. Integr. Pharm. Res. Pract. 2021, 10, 33–41. [PubMed] 10. Sanyal, C. Economic burden of opioid crisis and the role of pharmacist-led interventions. J. Am. Pharm. Assoc. 2021, 61, e70–e74. 11. Dubé, P.-A.; Vachon, J.; Sirois, C.; Roy, É. Opioid prescribing and dispensing: Experiences and perspectives from a survey of community pharmacists practising in the province of Quebec. Can. Pharm. J. 2018, 151, 408–418. [PubMed] 12. Jacobs, S.C.; Son, E.K.; Tat, C.; Chiao, P.; Dulay, M.; Ludwig, A. Implementing an opioid risk assessment telephone clinic: Outcomes from a pharmacist-led initiative in a large Veterans Health Administration primary care clinic, December 15, 2014–March 31, 2015. Subst. Abus. 2016, 37, 15–19. 13. Strand, M.A.; Eukel, H.; Burck, S. Moving opioid misuse prevention upstream: A pilot study of community pharmacists screening for opioid misuse risk. Res. Social Adm. Pharm. 2019, 15, 1032–1036. 14. Bhimji, H.; Landry, E.; Jorgenson, D. Impact of pharmacist-led medication assessments on opioid utilization. Can. Pharm. J. 2020, 153, 148–152. 15. Veettil, S.K.; Darouiche, G.; Sawangjit, R.; Cox, N.; Lai, N.M.; Chaiyakunapruk, N. Effects of pharmacist interventions on pain intensity: Systematic review and meta-analysis of randomized controlled trials. J. Am. Pharm. Assoc. 2022, 62, 1313–1320.e6. 16. Difference between PubMed, Embase, Web of Science and Scopus. Mercer University School of Medicine Skelton Medical Libraries. Available online: https://med.mercer.edu/library/database-differences.htm (accessed on 1 March 2023). 17. Cochran, G.; Chen, Q.; Field, C.; Seybert, A.L.; Hruschak, V.; Jaber, A.; Gordon, A.J.; Tarter, R. A community pharmacy-led intervention for opioid medication misuse: A small-scale randomized clinical trial. Drug Alcohol Depend. 2019, 205, 107570. 18. Chronic Pain MedsCheck Trial. Medical Services Advisory Committee. Updated 27 October 2022. Available online: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/B92576672643EF4FCA25876D000363D1/$File/CPMC%20 Consultation%20Summary.pdf (accessed on 1 March 2023). 19. Manzur, V.; Mirzaian, E.; Huynh, T.; Lien, A.; Ly, K.; Wong, H.; Wang, M.; Lou, M.; Durham, M. Implementation and assessment of a pilot, community pharmacy-based, opioid pain medication management program. J. Am. Pharm. Assoc. 2020, 60, 497–502. [PubMed] 20. Thakur, T.; Frey, M.; Chewning, B. Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States. Pharmacy 2019, 7, 60. [PubMed] 21. Nielsen, S.; Sanfilippo, P.; Picco, L.; Bruno, R.; Kowalski, M.; Wood, P.; Larney, S. What predicts pharmacists’ engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy. Int. J. Clin. Pharm. 2021, 43, 420–429. [PubMed] 22. Nielsen, S.; Picco, L.; Kowalski, M.; Sanfilippo, P.; Wood, P.; Larney, S.; Bruno, R.; Ritter, A. Routine opioid outcome monitoring in community pharmacy: Outcomes from an open-label single-arm implementation-effectiveness pilot study. Res. Social Adm. Pharm. 2020, 16, 1694–1701. [PubMed] 23. Frenzel, O.C.; Eukel, H.; Skoy, E.; Werremeyer, A.; Steig, J.; Strand, M. Examining Attitudes and Beliefs that Inhibit Pharmacist Implementation of a Statewide Opioid Harm Reduction Program. Innov. Pharm. 2020, 11, 1–6. [PubMed] 24. Fleming, M.L.; Bapat, S.S.; Varisco, T.J. Using the theory of planned behavior to investigate community pharmacists’ beliefs regarding engaging patients about prescription drug misuse. Res. Social Adm. Pharm. 2019, 15, 992–999. 25. Cid, A.; Daskalakis, G.; Grindrod, K.; Beazely, M.A. What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review. Pharmacy 2021, 9, 30. 26. Werremeyer, A.; Mosher, S.; Eukel, H.; Skoy, E.; Steig, J.; Frenzel, O.; Strand, M.A. Pharmacists’ stigma toward patients engaged in opioid misuse: When “social distance” does not mean disease prevention. Subst. Abus. 2021, 42, 919–926. 27. Werremeyer, A.; Strand, M.A.; Eukel, H.; Skoy, E.; Steig, J.; Frenzel, O. Longitudinal evaluation of pharmacists’ social distance preference and attitudes toward patients with opioid misuse following an educational training program. Subst. Abus. 2022, 43, 1051–1056. 28. Eukel, H.N.; Skoy, E.; Werremeyer, A.; Burck, S.; Strand, M. Changes in Pharmacists’ Perceptions After a Training in Opioid Misuse and Accidental Overdose Prevention. J. Contin. Educ. Health Prof. 2019, 39, 7–12. 29. Alenezi, A.; Yahyouche, A.; Paudyal, V. Roles, barriers and behavioral determinants related to community pharmacists’ in- volvement in optimizing opioid therapy for chronic pain: A qualitative study. Int. J. Clin. Pharm. 2022, 44, 180–191. [PubMed] 30. Bishop, L.D.; Rosenberg-Yunger, Z.R.S.; Dattani, S. Pharmacists’ perceptions of the Canadian opioid regulatory exemptions on patient care and opioid stewardship. Can. Pharm. J. 2021, 154, 394–403. [PubMed] 31. Health Canada. Subsection 56(1) Class Exemption for Patients, Practitioners and Pharmacists Prescribing and Providing Controlled Substances in Canada. Government of Canada. Updated 15 November 2021. Available online: https://www.canada. ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy-regulations/policy- documents/section-56-1-class-exemption-patients-pharmacists-practitioners-controlled-substances-covid-19-pandemic.html (accessed on 20 October 2022). 32. Health Canada. Frequently Asked Questions: Subsection 56(1) Class Exemption for Patients, Practitioners and Pharmacists Pre- scribing and Providing Controlled Substances in Canada. Government of Canada. Updated 15 November 2021. Available online: https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy- regulations/policy-documents/section-56-1-class-exemption-patients-pharmacists-practitioners-controlled-substances-covid- 19-pandemic/frequently-asked-questions.html (accessed on 16 November 2022). 33. Canadian Pharmacists Association. What Can Pharmacists Do under the Controlled Drugs and Substances Act (CDSA) during the COVID-19 Pandemic? Updated 2 March 2021. Available online: https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on- the-issues/CDSA-Extending_EN.pdf (accessed on 16 November 2022). 34. Houle, S.K.; Grindrod, K.A.; Chatterley, T.; Tsuyuki, R.T. Paying pharmacists for patient care: A systematic review of remunerated pharmacy clinical care services. Can. Pharm. J. 2014, 147, 209–232. 35. Dispensing Components Included in the Usual and Customary Fee. Ontario College of Pharmacists. Updated 2011. Available online: https://www.ocpinfo.com/regulations-standards/practice-policies-guidelines/usual-customary/#:~:text=Usual%20 and%20Customary%20Dispensing%20Fee%3A,the%20conditions%20established%20by%20R.R.O (accessed on 1 March 2023). 36. Hughes, C.A.; Breault, R.R.; Hicks, D.; Schindel, T.J. Positioning pharmacists’ roles in primary health care: A discourse analysis of the compensation plan in Alberta, Canada. BMC Health Serv. Res. 2017, 17, 770. [PubMed] 37. Dinh, T.; Stonebridge, C.; Brichta, J. A review of Pharmacy Services in Canada and the Health and Economic Evidence. Canadian Pharmacists’ Association. Published February 2016. Available online: https://www.pharmacists.ca/cpha-ca/assets/File/cpha- on-the-issues/Pharmacy%20Services%20Report%201.pdf (accessed on 1 March 2023). 38. Rezahi, S.; Mathers, A.; Patel, P.; Tilli, T.; Dolovich, L. Telehealth in community pharmacy: A new “place” for the appointment- based model given COVID-19 and the future of health care. Can. Pharm. J. 2021, 154, 363–367. 39. Chimbar, L.; Moleta, Y. Naloxone Effectiveness: A Systematic Review. J. Addict. Nurs. 2018, 29, 167–171. 40. Cherrier, N.; Kearon, J.; Tetreault, R.; Garasia, S.; Guindon, E. Community Distribution of Naloxone: A Systematic Review of Economic Evaluations. Pharm. Open 2022, 6, 329–342. 41. Green, B.N.; Johnson, C.D.; Adams, A. Writing narrative literature reviews for peer-reviewed journals: Secrets of the trade. J. Chiropr. Med. 2006, 5, 101–117.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.