In the Journals

Pharmacists improve opioid prescribing patterns

Nicholas Cox
Nicholas Cox

Providing clinicians with pharmacist recommendations on a patient’s opioid use before the patient visits for management of chronic pain led to less opioid use and did not lead to an increase in pain scores, according to research recently published in the Journal of the American Board of Family Medicine.

“Everyone knows something needs to be done [about the opioid epidemic], but nobody quite knows exactly how to address the problem,” Nicholas Cox, PharmD, of the department of family and preventive medicine at University of Utah Health, told Healio Family Medicine. “The CDC and others state that team-based care is critical for treating chronic pain. However ... there are few studies investigating how to incorporate pharmacists into the chronic pain management in a family medicine setting.”

Researchers noted that primary care providers are responsible for 50% of opioid prescriptions.

Cox and colleagues had a pharmacist review the charts of 45 patients who were prescribed 50 morphine milligram equivalents or more the day prior to the patients’ appointments. Most (n = 67) had an unspecified joint pain. The pharmacist then suggested how much medication to prescribe to the patient’s provider.

Researchers found that 4 months later, patient chart reviews showed no change in the patients’ pain scores (P = .783). However, other outcomes before and after the pharmacist’s intervention saw statistically significant improvement:

  • mean morphine milligram equivalents taken (P < .001);
  • current urine drug screen results (P < .001);
  • current review of the state’s prescription drug management program (P < .001);
  • patients prescribed a bowel regimen (P < .001);
  • mean number of nonopioid analgesics prescribed (P = .002);
  • patients taking benzodiazepines (P = .008);
  • patients offered outpatient naloxone prescription (P = .009);
  • referral to a pain specialist (P = .046); and
  • mean number of opioid analgesics prescribed.

“The thing that surprised me the most was the improvements we saw across the board, in nearly all opioid safety outcomes we evaluated in 4 months — such a short period of time,” Cox said in the interview.

He added pharmacists are “uniquely qualified” to assist in managing chronic pain.

“Given the profound impact pharmacists have had in helping manage other complicated, ‘medication-heavy’ therapeutic areas (eg, anticoagulation, transplant), pharmacists are poised to have an equally impressive impact on chronic pain, because chronic pain is complicated and often requires medication therapy with medications with potential deadly risks if not used appropriately,” Cox said.

He added that next steps include validating the study’s results on a larger scale and looking into other ways pharmacists can assist in managing chronic pain. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.

Nicholas Cox
Nicholas Cox

Providing clinicians with pharmacist recommendations on a patient’s opioid use before the patient visits for management of chronic pain led to less opioid use and did not lead to an increase in pain scores, according to research recently published in the Journal of the American Board of Family Medicine.

“Everyone knows something needs to be done [about the opioid epidemic], but nobody quite knows exactly how to address the problem,” Nicholas Cox, PharmD, of the department of family and preventive medicine at University of Utah Health, told Healio Family Medicine. “The CDC and others state that team-based care is critical for treating chronic pain. However ... there are few studies investigating how to incorporate pharmacists into the chronic pain management in a family medicine setting.”

Researchers noted that primary care providers are responsible for 50% of opioid prescriptions.

Cox and colleagues had a pharmacist review the charts of 45 patients who were prescribed 50 morphine milligram equivalents or more the day prior to the patients’ appointments. Most (n = 67) had an unspecified joint pain. The pharmacist then suggested how much medication to prescribe to the patient’s provider.

Researchers found that 4 months later, patient chart reviews showed no change in the patients’ pain scores (P = .783). However, other outcomes before and after the pharmacist’s intervention saw statistically significant improvement:

  • mean morphine milligram equivalents taken (P < .001);
  • current urine drug screen results (P < .001);
  • current review of the state’s prescription drug management program (P < .001);
  • patients prescribed a bowel regimen (P < .001);
  • mean number of nonopioid analgesics prescribed (P = .002);
  • patients taking benzodiazepines (P = .008);
  • patients offered outpatient naloxone prescription (P = .009);
  • referral to a pain specialist (P = .046); and
  • mean number of opioid analgesics prescribed.

“The thing that surprised me the most was the improvements we saw across the board, in nearly all opioid safety outcomes we evaluated in 4 months — such a short period of time,” Cox said in the interview.

He added pharmacists are “uniquely qualified” to assist in managing chronic pain.

“Given the profound impact pharmacists have had in helping manage other complicated, ‘medication-heavy’ therapeutic areas (eg, anticoagulation, transplant), pharmacists are poised to have an equally impressive impact on chronic pain, because chronic pain is complicated and often requires medication therapy with medications with potential deadly risks if not used appropriately,” Cox said.

He added that next steps include validating the study’s results on a larger scale and looking into other ways pharmacists can assist in managing chronic pain. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.

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