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.
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?
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?
- 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (MAGICapp)
- Opioid Manager Toolkit
- Every Pharmacist is an Opioid Steward: Putting the 2017 Canadian Opioid Guideline into Action (Pharmacy Connection, Spring 2019)
- Quality Standard: Opioid Prescribing for Chronic Pain
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?
- OPA – Pharmacist Clinical Tool for Initiating Naloxone Discussions
- CAMH – Preventing Opioid Overdose Fact Sheet
- Benzodiazepine Use – CEP
- Naloxone module – Pharmacy5in5
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?
- Checklist for Starting or Continuing a Trial of Opioid Therapy – Section A of Opioid Manager
- Pharmacists Virtual Communication Toolkit: Engaging in Effective Conversations About Opioids (NAPRA)
- Assessing Opioid Prescriptions module – Pharmacy 5in5
- Opioid Policy
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?
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?
- Documentation – Essential to a Patient’s Continuity of Care (Pharmacy Connection, Fall 2018)
- Quality Indicators for Pharmacy Data and Resources