A New Opioid Prescription: What Should You Consider?


In conducting community pharmacist practice assessments, the College’s practice advisors have noted that there is an opportunity for pharmacists to ensure they are considering clinical guidelines or recommendations regarding opioid therapy and applying them to their practice consistently. This article is intended to walk through what a pharmacist should consider when deciding whether to dispense and how to communicate/educate the patient.

SCENARIO A patient of your pharmacy presented a new prescription for OxyNeo® 40mg Sig: ii bid for severe chronic arthritis. This prescription is intended to be a switch from their current prescription for HydroMorph Contin® 18mg Sig: i bid. The patient also had a prescription for a benzodiazepine.

What Can You Consider When Assessing this Prescription and Communicating with the Patient?


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GUIDELINES AND RECOMMENDATIONS

What updated recommendations regarding opioid prescribing/dispensing could influence how you assess this prescription and communicate to the patient?


What is the Morphine Milligram Equivalents (MME) of the new prescription? Does it present risks to the patient (i.e. conversion errors between the current and new prescription)? Does it reflect best practices in opioid stewardship?


KEY RESOURCES


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RISK FACTORS FOR OVERDOSE OR OTHER HARMS FROM OPIOID USE

Is the prescription being co-dispensed with benzodiazepines? If so, what risks does this present to the patient and how can they be mitigated?


Can you proactively offer naloxone? How can you communicate the need for naloxone while being sensitive to concerns or assumptions patients have about naloxone and who it is for?


KEY RESOURCES


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PATIENT ASSESSMENT AND EDUCATION

What is the indication for therapy? Does that indication affect how you could optimize the therapy?


What other therapies have been tried? Are there alternative and complementary treatments or strategies that could help (e.g. physiotherapy)?


How does the patient rate their pain? Does the patient understand how their opioid use could contribute to the pain or other symptoms they may be having?


KEY RESOURCES


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COLLABORATION WITH THE PRESCRIBER

What information should you provide the prescriber about your approach to this prescription, your communication with the patient and your overall recommendations?


How else can you be involved in working collaboratively with the prescriber to support this patient?


KEY RESOURCES


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DOCUMENTATION, MONITORING AND FOLLOW UP

How will you monitor and follow up with this patient to assess whether their medication needs have changed? Do you have an approach for keeping the conversation going with this patient regarding their opioid use?


What is your documentation strategy for this patient so that all pharmacists at the pharmacy are aware of what has been discussed and the next steps?


How does your pharmacy’s dispensing of opioids compare to others in your area as per the Quality Indicators for Pharmacy?


KEY RESOURCES