Episode 6: Opioid Stewardship Part 2 with Oscar Santalo and Olga Ivanova

Definition

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

Background

1. The opioid crisis and the need for Opioid and Pain Stewardship program is widely recognized
2. Limited evidence on the structure of opioid and pain stewardship models for health-systems in the literature
3. Some level of recommendations exist from accrediting and professional organizations
4. Some success stories of implementing a pain stewardship committee and a pharmacist-led pain-management initiative

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

1. CDC promotes integrated, collaborative pain management and practice models that include pharmacists
2. NQP Opioid Stewardship action team has pharmacy involvement
3. ASHP advocates for the roles of a pharmacist in the opioid crisis

Examples of other programs

1. Intermountain Healthcare (stop, caution, go approach)
   1. Stop > avoid prescribing long acting opioids for acute conditions & dose > 50 mg morphine equiv/day
   2. Caution > patients at risk for overdose or abuse
   3. Go> prescribe lowest effective, integrate multimodal therapies, patient education
2. VA Prescribing guidelines:
   1. Review PDMP, Limit day supply of opioids, encourage to consult pain mgmt., not prescribe long-acting opioids
   2. A 500 bed hospital recognized in APhA for their program
   3. Pharmacy led program > receive pain mgmt. consults and run daily reports
   4. From 2013-2015  > Pharmacists have made 2,267 interventions, which Estimated an indirect cost avoidance of $2.7 million
   5. Initially executing 16 consults per month >  45 consults per month
   6. 59% reduction in opioid-associated rapid response calls and code blues
   7. An overall reduction in the use of high-risk medications on patients

Implementation Strategy For Opioid Stewardship Program At Your Health System

Electing a physician champion, Engaging executives, establishing a committee, and creating a pharmacy-led program

References

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. Johnson PE, Jorgensen JA. Pharmacy and the C-Suite: Managing the Interface.  Pharmacy Leadership Forum. http://www.ashpmedia.org/pai/csuitetoolkit/ (Accessed 2018 July 25)
6. American Physical Therapy Association. APTA Contributes to New ‘Playbook’ on Pain Management and Opioid Stewardship. APTA. http://www.apta.org/PTinMotion/News/2018/03/12/NQFOpioidPlaybook/. Accessed November 15, 2018.
7. Erickson, A.K. (2015). Knocking out pain: Hospital pharmacists launch new approach to pain management. Pharmacist.com. Accessed November 15, 2018.  https://www.pharmacist.com/article/knocking-out-pain-hospital-pharmacists-launch-new-approach-pain-management.

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