Phar­ma­cists to do an as­sess­ment of any­one look­ing for opi­oids

Medicine Hat News - - COMMUNITY - GIL­LIAN SLADE gslade@medicine­hat­ Twit­ter: MHNGil­lianSlade

New guide­lines for phar­ma­cists dis­pens­ing an opi­oid med­i­ca­tion were in­tro­duced Oct. 1.

The phar­ma­cist must now com­plete a thor­ough as­sess­ment of the per­son with an opi­oid pre­scrip­tion or if they are buy­ing an ex­empted codeine prod­uct that does not re­quire a pre­scrip­tion.

“We ex­pect a phar­ma­cist no mater what the pre­scrip­tion is that they as­sess each pa­tient, make sure that it is the ap­pro­pri­ate med­i­ca­tion for their con­di­tion or even if med­i­ca­tion is re­quired at all,” said Barry Strader, com­mu­ni­ca­tions di­rec­tor for the Al­berta Col­lege of Phar­ma­cists. “They’re like that sec­ond set of eyes after they’ve seen their doc­tor, just to go over ev­ery­thing.”

The as­sess­ment by the phar­ma­cist must in­clude a re­view of the Elec­tronic Health Record (Net­care) ev­ery time a pre­scrip­tion for an opi­oid med­i­ca­tion is dis­pensed or sold. The phar­ma­cist must doc­u­ment de­tails of the as­sess­ment with a writ­ten treat­ment plan for those us­ing an opi­oid on a long-term ba­sis or for those con­sid­ered to be at high risk for mis­use or ad­dic­tion, say the guide­lines.

“When the pa­tient is on long-term opi­oid ther­apy, or per­haps at high risk of mis­use or ad­dic­tion, then they have to de­velop a treat­ment plan for that in­di­vid­ual,” said Strader.

The phar­ma­cist is re­quired to col­lab­o­rate with the pre­scriber in­volved in the care of the in­di­vid­ual us­ing opi­oid med­i­ca­tion. The pa­tient must also be mon­i­tored by the phar­ma­cist for “signs of opi­oid mis­use, di­ver­sion or ad­dic­tion, and take ap­pro­pri­ate ac­tion”.

“If peo­ple are com­ing in for early re­lease of their med­i­ca­tion of­ten that could be a sign that they’re de­pen­dent or mis­us­ing the med­i­ca­tion,” said Strader.

Guide­lines on the Al­berta Col­lege of Phar­ma­cists web­site also say the phar­ma­cist must work with the pa­tient to es­tab­lish “re­al­is­tic ex­pec­ta­tions for pain man­age­ment,” to help them un­der­stand opi­oid med­i­ca­tion is not a “cure” and make them aware of the risks of tak­ing an opi­oid med­i­ca­tion.

The goal of the phar­ma­cist’s as­sess­ment is to en­sure pa­tients and pre­scribers con­sider all the ap­pro­pri­ate options be­fore opi­oid ther­apy and that they are be­ing closely mon­i­tored.

Rather than a du­pli­cate of what doc­tors are do­ing it is more about be­ing a “dou­ble check” to en­sure what is pre­scribed is ap­pro­pri­ate for that pa­tient for their con­di­tion, said Strader.

“I think that we can all agree that the opi­oid cri­sis has put a real spot­light on how opi­oid med­i­ca­tions are be­ing pre­scribed and how they’re be­ing taken and so phar­ma­cists have a big role in that,” said Strader, not­ing it is with the safety of the pa­tient in mind.

“Also, mak­ing sure that the med­i­ca­tion they’ve been pre­scribed is the best one for their con­di­tion. Some­times it is not an opi­oid. That’s where the phar­ma­cist can help make that call.”

Be­fore in­tro­duc­ing the new guide­lines ACP col­lab­o­rated with the Col­lege of Physi­cians and Sur­geons Al­berta, which was well aware and in sup­port of the guide­lines, said Strader.

A spokesper­son for CPSA says there has been very lit­tle feed­back from physi­cians on how the phar­ma­cist guide­lines are work­ing.

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