Pharmacists and the Opioid Epidemic: Tools You Can Use

Trey Burry, PharmD

As essential members of the health care team, pharmacists are on the front lines of the opioid epidemic working to address prescription opioid abuse and overdose.

Pharmacists have multifaceted roles in dispensing opioid pain medications including evaluating new prescription orders with concurrent treatments, ensuring medications are appropriately prescribed, and assessing prescription orders for forgery or alteration. Pharmacists communicate with patients regarding proper use of medications, common side effects and potential risks, refill requirements, and how to safely store and dispose of unused medications to prevent diversion or misuse.

Dispensing opioid medications has become increasingly complex to navigate as pharmacists seek to provide optimal care to patients while safeguarding against liability. It is crucial that pharmacies perform their due diligence in carrying out opioid dispensing processes such as checking state prescription drug monitoring programs, identifying red flags, communicating with the prescriber or patient when concerned, and appropriately documenting provider or patient interactions. One tool that can be used to improve health care delivery and prevent opioid abuse is a safe opioid dispensing policy or opioid pledge.

The intent of an opioid pledge is to deliver upfront expectations around opioid prescriptions to patients with the purpose of initiating a dialog between pharmacists and patients regarding opioid safety and stewardship. When pharmacies adopt and implement an opioid pledge it generates consistency, formalizes dispensing policies and practices, facilitates the training of pharmacy staff, eliminates confusion about early fills or refill dates, creates transparency for patients regarding the dispensing process, increases awareness for the actions the pharmacy is taking, and decreases the likelihood of meeting DEA quantity limits on controlled substances.

Opioid pledges can be formatted according to the needs and preferences of the pharmacy but should include the purpose of the pledge, what the pharmacy is committing to the patient, and expectations for the patient in the opioid dispensing process. A list of pharmacy responsibilities may include helping to ensure patient safety, communicating with prescribers, assessing treatment response, providing disposal resources, and offering and providing naloxone. Patient responsibilities may include using the medication as intended and prescribed, being aware of risks, understanding limitations on early refills, proper storage and disposal of medication, and speaking to prescribers before making dosage or frequency changes.

Numerous independent community pharmacies across Florida implemented an opioid pledge in their dispensing process as a part of Flip the Pharmacy, a program coordinated and offered by the Community Enhanced Services Network (CPESN). Notably, a law was amended in July of 2022 that allows Florida pharmacists to dispense an emergency opioid antagonist without a prescription. Given the recent law amendment, pharmacies participating in the program last summer made educating patients on the availability of naloxone a major aspect of enacting the pledge.

Over a few months, every patient that picked up a chronic opioid prescription received an opioid pledge to review and sign before speaking to a pharmacist. The pharmacist discussed the opioid pledge with the patient in a private area, reviewed at least two to three points on the pledge, and signed the pledge to acknowledge their responsibilities. Every patient was offered naloxone during this conversation, regardless of MME or overdose risk, and told that they could receive the medication at any time in the future without a prescription. The pledge was then scanned into the patient’s profile before being given to the patient to keep. The pledge received positive feedback among pharmacies and patients with dozens of patients receiving prescriptions and counseling for naloxone.

Pharmacists are on the front lines of the opioid epidemic engaging in prevention and treatment efforts to combat opioid use disorder and overdose. In an arsenal of weapons pharmacists may find the opioid pledge a formidable tool in dispensing opioid pain medications and providing medicationrelated services.

CPESN Florida is a statewide network of Florida community pharmacy practices dedicated to serving our patients with enhanced services and working collaboratively with other members of the healthcare team to improve patient health outcomes. For more information visit https:// cpesn.com/networks/cpesn-florida

Flip The Pharmacy is a program that is coordinated and offered by CPESN USA for member pharmacies. Information about this program can be found at www. flipthepharmacy.com. Resources related to creating and implementing an opioid pledge program are available at www. flipthepharmacy.com/opioid-focus.

1. “Drug Overdose Death Rates.” National Institutes of Health, U.S. Department of Health and Human Services, 9 Feb. 2023, https://nida.nih.gov/research-topics/trendsstatistics/overdose-death-rates.

The FPA Institute on Substance Use Disorder explores the pharmacist’s role in addressing and preventing addiction in a healthy way

From recommending holist c approaches to cultivating an empathetic culture toward add ction the education that participants receive here will equip them to provide effective and top of the l ne care for the patients in their community

Peter Swaan, PhD, MPharm

Anita Jacobson

8 00 am – 9 30 am May 20 2023

Communication is Key Talking to Patients with OUD

Improve communication with pat ents n order to overcome obstacles to optimal outcomes

9 30 am – 11:00 am May 20, 2023

Myths can Kill How to Approach Overdose and Mis nformation

Discover different discip ines and practices that can ass st in treat ng people w th OUD

Emily Leppien

11:00 am – 1 00 pm May 20 2023

Op oid Use D sorder: Beyond the Medicine

Educate pharmac sts about the different discip ines and practices that can ass st in treat ng people w th OUD

Jake Nichols

1:30pm – 3:00 pm May 20, 2023

The Self in Shame Heal ng the Wounds of Substance Use Disorders

The many types of shame, strategies to prevent unhealthy shame dur ng substance use disorder recovery, and how to apply th s knowledge for your patients

Dr. Thomas Franko

8:00 am – 9:30 am May 21, 2023

Advocacy Hour: Tools to change OUD treatment forever

Legislat ve actions that pharmac sts can take to advocate for their pat ents need for OUD treatment and expand the profess on of pharmacy so that pharmacists can continue to provide except onal pat ent care regardless of practice type

Jeffery Gold

10:00 am – 11:30 am May 21, 2023

Addiction and the Vulnerable Self Pract cing Self-Compass on n Recovery

Self-care sounds l ke an easy and s mple task but the reality is that most pharmacists struggle to find healthy ways to take care of themselves

Nancy Alvarez

12:00 pm – 1:30 pm May 21, 2023

Addressing Social Determinants of Health in Opioid Use Disorder

Learn about SDOH and ways to improve pat ent access to care despite the sign f cant barriers to care that some patients face

Scott Coon and Matthew Girard Hermenau

2 00 pm – 3:30 pm May 21, 2023

Creat ng a Culture of Trust; Harm Reduction in Marginalized Communities

Tools to mitigate r sk for patients m susing opioids and to communicate most effective y with providers in your area regarding prescrib ng these medications

Let me begin by first introducing myself to the Florida Pharmacy Association membership. My tenure as dean of the University of Florida College of Pharmacy began on Dec. 1, and I am thrilled to lead such an accomplished and well-respected pharmacy college. I spent the past two decades at the University of Maryland School of Pharmacy, where I held several leadership roles. Most recently, I served as the associate dean for research and advanced graduate education as well as a distinguished professor and chair in the department of pharmaceutical sciences. My academic and professional career includes stops at other premier pharmacy colleges, including the University of Michigan; the University of California, San Francisco; the Ohio State University; the University of Maryland; and now the University of Florida.

My arrival corresponds with a major milestone in the history of the UF College of Pharmacy, as our college celebrates its centennial in 2023. The Florida Pharmacy Association played an important role in the establishment of the UF College of Pharmacy. In the early 1920s, FPA members recognized the need for a pharmacy school in Florida to provide advanced education and training to pharmacists in the state. There were no pharmacy schools in Florida at the time, and the existing pharmacy programs in other states were not easily accessible to Floridians. FPA leaders advocated for the creation of a pharmacy college at UF. They worked with university leaders and state legislators to secure funding for the new school, and in 1923, the UF College of Pharmacy was established.

Over the years, FPA has been an important partner of the UF College of Pharmacy. The organization has supported the college through scholarships, continuing education programs and other initiatives. FPA and the UF College of Pharmacy have worked together to advocate for the profession in Tallahassee and highlight the important role pharmacists play in providing health care to our state. UF College of Pharmacy faculty have also assumed various leadership roles in FPA and volunteered to advance the organization. Carol Motycka, Pharm.D., a clinical professor and assistant dean of our Jacksonville campus, is currently serving a one-year term as FPA president.

As the UF College of Pharmacy prepares to enter its second century, we owe a debt of gratitude to the Florida Pharmacy Association for its role in our founding and its continued support of pharmacy education in our state. Thank you to everyone at FPA who has helped the UF College of Pharmacy achieve 100 years of pharmacy greatness.

Thursday July 6, 2023

7:00am Registration Desk Opens

7:00-8:00 Breakfast

7:45am Welcome and Introductions

8:00am-10:00am Delegate Registration

8:00am-9:30am CE/RC

Leading in Times of Trauma: Helping Frontline Heroes Cope with Burnout with Helen Sairany

10:00am-12:00pm CE

To Fill or not to Fill: Addressing Addiction in Community Settings with Jake Nichols

11:00 am-11:30am

FPA Annual Business Meeting

7:00am Registration Desk O

7:00-8:00 Breakfast

8:00am-9:30am CE/RC s of CBD Products and with Steve Cutler

11:00am Pharmacy Car

Theresa Tolle

0:00am-11:30am CE/RC ning Keynote with Jerry Mo

Family Matters: Helping Families through the Epidemic of Addiction

11:30am-1:30pm

Exhibit Hall Grand Opening

11:30am-1:30pm

Student Poster Presentations

12:00pm-1:00pm

Lunch in the Exhibit Hall

12:30pm-1:30pm

Local Unit Leaders Meeting

1:30pm-3:00pm CE/RC

The Community Champions: Inspire Your Team to Fill Unmet Needs in the Community with Annie Eisenbeis

2:15pm-3:45pm CE/RC

Dialing Down on Benzodiazepines with Sarah Melton

4:00pm-6:00pm

House of Delegates Reconvenes- if necessary

7:00pm-9:00pm FPPC Reception Presidents 250 Club Reception

3:30pm-5:00pm CE

NASPA/NMA Self-Care Bowl

Facilitated by Genevieve Hale

5:00pm-6:30pm

University Alumni Receptions

6:30pm- 8:00pm

Foundation Celebration

Saturday July 8, 2023

6:30am 5K Fun and Walk

7:00am Florida Independent Pharmacy Owner Breakfast

7:00- 8:00am Breakfast

8:00am-9:30 am CE/RC

Collaborate for Success: The Ingredients of a Healthcare Dream Team with Amina Abubakar and Stephen Lewis

9:00am-11:00am Student Patient Counseling Competition

10:00am-11:30am CE/RC

Closing Keynote with Doug Hoey and Josh Lenchus

The Future of Pharmacy: Challenges and Opportunities

11:30am-1:30pm Exhibit Hall 12:00pm-1:00pm

Lunch in the Exhibit Hall

1:00-2:00pm Student Awards Event

1:30pm-3:00 pm CE/RC

Inspiring your Team in Times of Uncertainty with Amina Abubakar

1:30pm-3:00 pm CE

The Role of State Laws & Regulations in PBM Reform with Greg Reybold and Antonio Ciacca

3:30pm-4:30 pm CE

Your Annual Update to State and National Initiatives with Claudia Devant, Senator Jason Brodeur, Rep. Shane Abb Rep Gallop Franklin, and Rep Linda Chaney

3:30pm-4:30pm CE

Threats to Pharmacy Compounding Patients and Practic with Scott Brunner

7:00pm-10:00pm Banquet and Awards with Silent Auction Lace Up and Don't Stop:

Wear Your Formal with Statement Sneakers

Sunday July 9, 2023

7:00am- 8:00am Sunday Morning Worship

Theresa Tolle

7:20am

Registration Desk Opens

8:00am-10:00am CE

Mastering at Medication Error Prevention: A Practical Guide for Pharmacists with Michael Jackson

10:30am-11:30am CE

Hacked! Securing Your Pharmacy Data and Handling the Breach with Paige Clark

11:30am-12:00pm Installation of Officers

A $20 daily resort fee and $100 daily incidental hold will be charged for your room on the personal credit card you check-in with.

FPA members will received a 50% discount on valet and self parking fees for the convention.