Wisconsin pharmacists recognize that opioid risk screening, overdose prevention education and naloxone dispensing in the pharmacy setting may help address the opioid misuse epidemic in the U.S., but may not be able to do this routinely due to feasibility issues and educational barriers.
Those were among the key findings of a small study by a UW-Madison Doctor of Pharmacy student and addiction medicine experts in the UW Department of Family Medicine and Community Health (DFMCH). The study was published in the July/August 2016 issue of the Journal of the Pharmacy Society of Wisconsin.
Opioid Risk Screening: Current Practices and Barriers
The researchers surveyed 300 pharmacists across Wisconsin; of those who responded, 93% identified a need for pharmacists to screen for opioid misuse. However, only 54% indicated that they currently perform screening, and 75% said they would benefit from additional education on screening.
Study results also showed that urban, community-based pharmacists were most likely to screen for opioid risk. All of the responding urban pharmacists reported screening, compared to 63% of suburban pharmacists and 41% of rural pharmacists.
Half of clinic-based pharmacists, 56% of community-based retail pharmacists and 57% of community-based independent pharmacists routinely screen. (No hospital-based pharmacists reported screening, but medication dispensing to inpatients usually occurs through nursing staff.)
Study authors said that a standardized, in-person screening instrument might help pharmacists detect opioid risk and intervene at the point of care, but such tools have not been investigated or developed.
Pharmacists also cited other barriers to opioid risk screening, including the inability to discuss prescribing habits with individual providers, inconsistent practice patterns between pharmacists, and lack of time and reimbursement for opioid-related screening and intervention activities.
“The results demonstrated that pharmacists are very interested in screening patients,” commented Alissa Hofer, a UW-Madison Doctor of Pharmacy candidate who was the study’s lead author. “The barriers to screening may be overcome, in part, by adding opioid screening services to existing statewide reimbursement programs for pharmacy services.”
Education on Overdose Prevention, Treatment
The researchers also asked pharmacists if they felt they had adequate training to appropriately dispense the overdose-reversing drug naloxone, and if they were comfortable dispensing it to laypeople who might witness an overdose.
Half answered “yes” to both questions, but only 42% felt that had adequate training to educate patients on how to recognize an overdose and properly administer the drug.
Survey respondents said that additional professional development in this area would benefit both them and people at risk for overdose. “To save a life would be a great thing,” said one respondent.
“As the ultimate dispensers of medication, pharmacists are uniquely positioned to help reduce the epidemic harms attributable to prescription opioids,” noted Randall Brown, MD, PhD, FASAM, the study’s last author. “This study is the first to begin to shed light on the significant work needed to understand what form that might take and how it might be fit into pharmacists’ customary workflows.”
Published: December 2016