Even if you’ve been avoiding the depressing evening news and have cut the newspaper from your budget, you’re probably still well aware we’re in the midst of an opioid epidemic.
The signs of the crisis are everywhere—even literally in many pharmacies, where naloxone is advertised as an antidote to opioid overdoses.
Every day, more than 116 people in the United States die after overdosing on opioids. The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse in America is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment and criminal justice involvement.
Signs of a crisis
Those of us who work in senior care environments experience the ripples from the opioid epidemic in ways that are not related to misuse or addiction. The crisis has created challenges with pain management that affect a resident’s quality of life.
The most obvious impact might be seen in the quality measures. An increased percentage of residents who report moderate to severe pain can reveal inadequate pain management, which requires a careful balance between non-pharmacologic interventions and safe prescribing.
With opioids in the news and increased prescriber scrutiny, physicians are sometimes reluctant to write prescriptions, or are confused by the rules around valid narcotic prescriptions in long-term care. This can lead to undertreatment, or delays in therapy.
Using opioids as a first-line weapon against pain is not supported by the CDC Opioid Prescribing Guidelines for Chronic Pain, and the benefits of their long-term use are not well supported by the evidence. But when there’s a short-term need, opioids can be vital to relieving acute pain. Clinicians should continue opioid therapy only if there is a clinically meaningful improvement in pain and function that outweighs risks to resident safety.
Another all-too-familiar sign of the crisis is the increased diversion, or theft, of opioids as they become harder to get for those misusing or illegally distributing. Regardless of the method of diversion, resident safety is always at risk. Diversion often involves falsification in documentation that can lead to clinical decisions resulting in unintentional overdose or undertreatment of pain, not to mention the impact on the regulatory and financial outcomes of the facility.
How pharmacy partnership can help
The word “epidemic” alone tells us that the ripple effect of the opioid crisis is a huge problem in senior care that no one can or should tackle alone. That’s what makes this the perfect opportunity for providers to engage their pharmacy partners to help in some very important ways:
- Medication management — Pharmacists are experts in medication safety and can assist with recommendations around the best treatment and monitoring parameters. Pharmacy nurses are experts in setting up safe medication management systems. Working together, they can guide facilities on how to use pharmacy data and reports to identify residents at risk for adverse events, or to detect potential diversion.
- Policies and procedures — Pharmacists and pharmacy nurses can also assist in the development of policies and procedures around pain management and controlled medications. Some opioids, such as the fentanyl patch, need its own guidelines to ensure safe and effective use.
- Opioid education — Pharmacy partners can also help educate the facility’s interdisciplinary team on the scope and impact of the opioid crisis. We can help prescribers and nurses become more familiar with the CDC’s prescribing guidelines, and provide nurses with education on pain assessment or coding tips for the MDS, which drive the quality measure. We can teach direct care staff, residents and family members about the use of medications and how to recognize an opioid adverse event, and show them great tools that can assist with this monitoring. Pharmacists can also collaborate with therapists in making recommendations for non-pharmacologic modalities.
- Narcotic reconciliation—In addition to practicing multifaceted approaches to good pain management, facilities need to have a strong system in place to account for the receipt and disposal of controlled medications, with sufficient detail to enable an accurate reconciliation. This is a regulatory requirement under F755, Pharmacy Services.
We also recommend that the pharmacist regularly evaluate the facility’s completion of a periodic reconciliation, and ensure it maintains an accurate account of all controlled medications. To help guide nurses through the narcotic reconciliation process, we have developed an audit tool. If—or rather, when—there are signs of diversion, your pharmacy partner should be there to guide you through the next steps.
The opioid epidemic is one of the most serious challenges this country faces, with far-reaching effects that ripple deep into senior care. By leveraging the expertise and experience of pharmacy partners, facilities can ensure residents receive safe, adequate and effective pain management—which ultimately is the only outcome that truly matters.
Terri Fagan is the director of clinical services at Consonus Pharmacy. Melissa Chase is the director of nurse consulting at Consonus Pharmacy.