Examining Trends in Long-Term Opioid Use, Importance of Pharmacist-Physician Collaboration
At APhA 2024, 2 posters looked into how collaboration between physicians and community pharmacists is crucial when it comes to opioid prescriptions, and current opioid use patterns among older adults.
The opioid epidemic in the United States has reached staggering levels, with data from the National Institute on Drug Abuse showing there were over 80000 overdose deaths involving opioids in 2021 alone.1 Although opioid misuse is a serious issue and represents a threat to public health, the drug is still used and is effective for treating certain conditions, such as chronic pain.
Prescription bottle for the opioid Oxycodone tablets and pills / steheap - stock.adobe.com
At the American Pharmacists Association 2024 Annual Meeting and Exposition, held in Orlando, Florida, from March 22 to 25, 2 posters looked further into the topic of opioid use. The research examined the importance of collaboration between physicians and community pharmacists when it comes to opioid prescriptions, as well as current opioid use patterns and trajectories among older adults.
In the first poster, investigators from the University of Georgia conducted a systematic review to assess current research on physician-pharmacist collaboration to reduce opioid-related risks, expand access to naloxone and medications for opioid use disorder (MOUD).2 A search of PubMed, Web of Science, CINAHL, and Google Scholar was conducted for research published between 2002 and 2023. The review included a total of 11 studies that met inclusion criteria.
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Investigators found that collaborative services offered by physicians and pharmacists included engaging with patients to optimize pain management, implementation of opioid risk-reduction strategies, and facilitating access to naloxone and MOUD. Many positive results came from the collaborative model, such as identification of medication-related problems, increased rates of MOUD treatment retention and adherence, and enhanced patient satisfaction. Physicians and pharmacists both reported positive attitudes about the collaboration.
However, pharmacists did report some barriers to participating in the collaborative model, such as hesitancy in questioning clinical decisions from physicians and difficulties in communicating directly with providers—though physicians said that pharmacists were easy to reach. Other challenges include a lack of trust, stigma surrounding opioids, and a lack of clearly defined roles and responsibilities.
"Increased collaboration between physicians and community pharmacists in optimizing opioid therapy could enhance patient engagement, contribute to the responsible use of opioids, reduce opioid-related risks, and improve patient safety,” the authors concluded. “Addressing challenges, such as issues of trust, communication barriers, reimbursement, and the need for clearly defined roles is crucial for the effective implementation of physician-pharmacist collaborative practices in enhancing opioid safety.”
In the second poster, investigators from the University of Wisconsin-Madison conducted a study to examine trends in long-term opioid treatment (LTOT) among Medicare beneficiaries in Wisconsin with chronic non-cancer pain (CNCP) and to assess trends in LTOT among different subpopulations.3 Data was gathered from enrollment and prescription drug claims data between 2016 and 2019 from Medicare beneficiaries enrolled in stand-alone Part D prescription drug plans.
The study found that Medicare Part D beneficiaries increased by 15.41% between 2016 and 2019, from 596517 to 688468. However, during the same period, beneficiaries eligible for high-dose opioids decreased by 17.38%, from 64,472 to 53,264. During the study period, the average daily morphine milligram equivalents per opioid prescription decreased from 43.96 to 38.78. Additionally, the average daily morphine milligram equivalents per beneficiary decreased from 27.42 in 2016 to 25.1 in 2019.
“After publication of the CDC guidelines for prescribing opioids for chronic pain in 2016, there was a decreasing trends in prescription opioid dispensing in the State of Wisconsin,” the authors concluded.
The authors noted that their future research will analyze high dose users, the annual cost of high dose prescription opioids by payers, initial diagnosis of LTOT for CNCP, and stratify the population by opioid formulation.
Read more of our coverage from the 2024 APhA Annual Meeting & Exposition here.
