Episode 5: Opioid StewardshipPart 1 with Oscar Santalo and Olga Ivanova

Oscar Santalo PharmD, MBA, MHA, BCPS


  1. Opioid Sparing – providing multi – modal medications that limit the use and supply of opioids
  2. Opioids – a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief.
  3. Opioid Addiction – a long-lasting (chronic) disease that can cause major health, social, and economic problems.
  4. Opioid and Pain Stewardship – the standardization of best practices to identify the best treatment options for pain management to limit the use and supply of opioids.
  5. PDMP – prescription drug monitoring program


  1. More than 130 people die every day from an opioid-related overdose (1 person every 15 min)
  2. In 2009 the number of opioid prescriptions increased by 68% reaching 202 million
  3. In 2010 hydrocodone/APAP (Norco) was the most commonly prescribed drug in the U.S.
  4. U.S. uses 99% of the world’s supply

What is the importance/relevance of this topic to pharmacy administration and pharmacy practice overall?

  1. Pain management is complicated
  2. Classifying pain, treatment options, and lack of pain specialists
  3. Regulatory firms and professional organizations have a significant role to play because of the guidelines they establish.

Major Endpoints/Takeaway

Organization Recommendation (Not All Inclusive)
The Centers for Disease Control and Prevention Integrated, collaborative pain management and practice models that include pharmacists
Centers for Medicare and Medicaid Services Expand naloxone use, distribution, and access
The Joint Commissions Identify a team that is responsible for pain management
American Pain Society Monitor patients receiving systemic opioids
Pharmacy Quality Alliance Provides core measure set to recognize high risk patients
National Comprehensive Cancer Network Provides an algorithm on how to manage pain
American Society for Pain Management Nursing Organizations should develop and implement policies/procedures

ED Opioid Stewardship Algorithm by Dr. Sergey Motov @painfreeED and Mahlaqa Butt


  1. Martin L, Laderman M, Hyatt J, Krueger J. Addressing the Opioid Crisis in the United States. IHI Innovation Report. Cambridge, Massachusetts: Institute for Healthcare Improvement; April 2016
  2. Bentley E.D. Pain Management Stewardship. ASHP Leadership Conference. Dallas, Tx. October 14, 2018.
  3. Dowell D, Haegerich, TM, and Chou, Roger. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. Centers for Disease Control Recommendations and Reports / March 18, 2016 / 65(1);1–49.
  4. Baker DW. The Joint Commission’s Pain Standards: Origins and Evolution. 2017. Oakbrook Terrace, IL: The Joint Commission. 
  5. American Board of Pain Medicine (2014). Why the US Should Develop a Primary Medical Specialty in Pain Medicine.  http://www.abpm.org/uploads/files/talking%20points%20-%20Florida%20approach%20needed%20final.pdf
  6. Haffajee RL, Jena AB, Weiner SG. Mandatory use of prescription drug monitoring programs.. JAMA. 2015 Mar 3;313(9):891-2. doi: 10.1001/jama.2014.18514. 
  7. Chou R, et al. Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’Committee on Regional Anesthesia, Executive Committee, and Administration Council. The Journal of Pain, 2016;17(2):131-157
  8. National Comprehensive Cancer Network (NCCN) Adult Cancer Pain. (Swarm, RA, Kamal, AH, Portman, DG, et al. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Published 2014)
  9. Pharmacy Quality Alliance (PQA) (Schmitz, R. . Opioid Core Measure Set. [online] Pqaalliance.org. Available at: https://www.pqaalliance.org/opioid-core-measure-set [Accessed 15 Nov. 2018].
  10. American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression. Pain Management Nursing, Vol 12, No 3 (September), 2011: pp 118-45.


Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

The Pharm So Hard Podcast is a show focused primarily on emergency medicine and hospital pharmacy related topics. To empower healthcare providers with the knowledge and skills they need to provide evidence-based, safe care for critically ill patients.

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