Q&A: Pharmacist Discusses How High Rates of Chronic Pain Could Impact the Field

Madison Irwin, PharmD, BCPS, is a clinical pharmacist specialist in palliative care at University of Michigan Health and a clinical assistant professor at University of Michigan College of Pharmacy. She supports a palliative care consult team and outpatient palliative care clinic by seeing patients who are transitioning out of the hospital or patients who have more complex medication management needs.

Q&A: Pharmacist Discusses How High Rates of Chronic Pain Could Impact the Field/ Alrandir - stock.adobe.com

In a conversation with Drug Topics, Irwin discussed how her career has unfolded, a program that she worked on that exemplifies the value of pharmacists in patient care, opportunities out there for pharmacists to expand their role, and how high rates of chronic pain will impact the pharmacy profession in the coming years.

Drug Topics: What initially drew you to the pharmacy profession and how has your career path unfolded?

Madison Irwin, PharmD, BCPS: I was not someone who was always like, “I'm going to be a pharmacist.” I wanted to pursue a PhD in neuroscience and was working on a bachelor's in biology. I took an organic chemistry class and really enjoyed it and found it interesting and wanted something where I could utilize that kind of knowledge. A friend at the time said that I should look into pharmacy, and I did, and kind of just went from there. What I liked with pharmacy was that there's so many different things that you can do. There's such a wide range of settings that you can work in as a pharmacist. I knew at the time that I thought I probably wanted to work in a hospital in the inpatient setting, and so after I graduated, I went to Ohio State for pharmacy school, and after that, I matched here at Michigan and did a PGY 1 residency, and was interested in many different things. A good friend of mine at the time asked if i had checked out palliative care and they said I should do a rotation in palliative care. I did and the rest is history. I did a PGY 2 in that and then did 2 years of fellowship. Now I'm in my current position where I practice both inpatient and outpatient, supporting our inpatient palliative care consult team and our outpatient palliative care clinics.

Drug Topics: Can you talk about some of the rewards and challenges you face in your practice setting?

Irwin: Everyone would identify this as a challenge, but there's limited time in my particular position. I'm split between outpatient, inpatient and being at the college. Navigating that is a challenge. Some of the rewards are getting to work with patients in the outpatient. The way that I support our outpatient clinics is that I have my own clinic twice a week and see patients who either are transitioning out of the hospital and going home, or those who maybe have more complex medication management needs, or just kind of complex needs overall. Getting to work with folks and getting to know them is really rewarding. There was one patient a while back, we made some not huge tweaks to his medication regimen, but it really made a big difference to him. We got to work together for many months, and then at one point he was in the hospital and said, “Well, you have to come by and see me when I'm here. I have a shirt that I'm having everyone that's on my ca.re team sign I need you to come sign it.” That was a really special patient to get to work with and get to know. I'd say that's one of the big rewards.

One of the other things is that, while I said time is always limited, as pharmacists were often able, at least in my setting, to see folks more frequently and for longer periods of time than any of the physicians. I have a little bit more time to just listen and I will often find things out not because I'm asking any particular kind of question, but just because I am spending the time and listening to folks. I'd say those are some of the big rewards.

Some of the challenges. Again, the time thing. I'd say the other thing is a misunderstanding from patients, families, and other health care professionals about what palliative care is and what appropriate pain management looks like. That can often create barriers, but we just keep providing that education and trying to get past that.

Drug Topics: Can you share something unique about your practice setting, patient population, or a specific program that you've implemented that exemplifies the value of pharmacists in patient care?

Irwin: There are a lot of different pharmacist led transitions of care programs out there. One of the unique things that we do with my clinic is we do a target of palliative care, specific transition of care. So, if a patient is seen in the hospital by the palliative care consult service, or if they follow with one of our clinics outpatient when they get discharged within a week or two, they'll have either a video visit or a phone visit with me to ensure that they're tolerating whatever adjustments or changes we made to their regimen. We're making sure that they don't need to come back if their symptoms are uncontrolled and making sure that they have Narcan and understand how to use it at home, because the majority of these patients are getting opioid pain medicine. I would say that is a valuable program that I've been a part of implementing. It really does go a long way to reduce the wait time for folks to be seen in our clinics. We can get people on more optimal regimens sooner by having the collaboration between myself and the palliative care clinic physicians.

Drug Topics: in your opinion, what are the biggest opportunities for pharmacists to expand their role in patient care in today's healthcare landscape?

Irwin: I think we're continuing to see that various kinds of chronic conditions that are primarily medically managed often do really well when pharmacists manage them. In some cases, like hypertension management, the CDC has that pharmacists should lead management in their guidelines. I think continuing to identify areas like that where pharmacists can really spend the time doing that kind of medication management with folks. There's always accessibility issues. As pharmacists, we need to continue to advance those kinds of roles. I am hopeful that that will continue to expand access to underserved folks.

Drug Topics: Rates of chronic pain among US adults remains high and new cases occur more frequently than other common conditions like diabetes. How do you think this will impact the pharmacy professionally in the coming years?

Irwin: Certainly, my practice specialty of pain management and palliative care is one that has grown quite a bit in the last 10 to 20 years. I think we'll continue to see more specialty residency programs. I think we'll continue to see more workforce development in terms of having greater numbers of pharmacists practicing in this area. I think there's a lot of opportunities there, as we continue to see high rates of chronic pain. Chronic pain is something that is oftentimes managed with medications, and so there's a good role there for pharmacists. But I also always say, one of my most important jobs as a pharmacist is to know when a medication is not the answer or not the only answer. I want to continue to encourage all my pharmacist colleagues to be aware of all of the non-medication, either interventional or behavioral, or different non-pharmacologic interventions that are out there for chronic pain and normalize them with patients and other healthcare professionals. Medications are only one tool in someone's toolbox. We can provide support there but really identifying other opportunities to get patients plugged in with other kinds of specialists.

To read more from this series, visit our American Pharmacists Month resource center.

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