- Opioid Sparing – providing multi – modal medications that limit the use and supply of opioids
- Opioids – a class of drugs that act in the nervous system to produce feelings of pleasure and pain relief.
- Opioid Addiction – a long-lasting (chronic) disease that can cause major health, social, and economic problems.
- 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.
- PDMP – prescription drug monitoring program
- The opioid crisis and the need for Opioid and Pain Stewardship program is widely recognized
- Limited evidence on the structure of opioid and pain stewardship models for health-systems in the literature
- Some level of recommendations exist from accrediting and professional organizations
- 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?
- CDC promotes integrated, collaborative pain management and practice models that include pharmacists
- NQP Opioid Stewardship action team has pharmacy involvement
- ASHP advocates for the roles of a pharmacist in the opioid crisis
Examples of other programs
- Intermountain Healthcare (stop, caution, go approach)
- Stop > avoid prescribing long acting opioids for acute conditions & dose > 50 mg morphine equiv/day
- Caution > patients at risk for overdose or abuse
- Go> prescribe lowest effective, integrate multimodal therapies, patient education
- VA Prescribing guidelines:
- Review PDMP, Limit day supply of opioids, encourage to consult pain mgmt., not prescribe long-acting opioids
- A 500 bed hospital recognized in APhA for their program
- Pharmacy led program > receive pain mgmt. consults and run daily reports
- From 2013-2015 > Pharmacists have made 2,267 interventions, which Estimated an indirect cost avoidance of $2.7 million
- Initially executing 16 consults per month > 45 consults per month
- 59% reduction in opioid-associated rapid response calls and code blues
- 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
- 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
- Bentley E.D. Pain Management Stewardship. ASHP Leadership Conference. Dallas, Tx. October 14, 2018.
- 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.
- Baker DW. The Joint Commission’s Pain Standards: Origins and Evolution. 2017. Oakbrook Terrace, IL: The Joint Commission.
- 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)
- 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.
- 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.