October 17, 2024 • 15 mins
In this episode, APhA Executive Education Fellows will discuss the recently published PhARM OUD guidelines designed to equip community pharmacists with essential tools to help them enhance patient care.
Each month, APhA will release two, 10 to 15 minute podcast episodes offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care. Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).
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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to the First Fill and happy
American Pharmacists month.
With it being American Pharmacists month,
we thought it was really important
to focus on the critical role
the pharmacist plays
in improving outcomes in public health
from serving as a vital community resource,
delivering hundreds of thousands of vaccines
to ensuring patients are on the right antibiotic
at the right dose for a life
(00:22):
threatening infection.
You as pharmacists play such an essential role
for your patients.
So thank you for all that you do.
Before we dive
in, I'd like to introduce my guests today
APhA executive fellows Nick and Yara.
Nick and Yara,
why don't you introduce yourselves?
Yeah. So.
Hi, I'm Nick,
one of the executive fellows in education.
(00:45):
Happy to be here.
Happy to get started on this.
Hello, I'm Yara
Al Shaer, and the other education fellow here.
All right.
Thanks, Nick and Yara for that.
More specifically,
this month,
we're going to focus on the great work
pharmacists are doing to support
patients with substance use disorder.
According to a 2022 national survey
on drug use and health
(01:06):
data released by HHS and SAMHSA,
48.7 million people aged 12 and older,
or 17.4% of the US population had a substance
use disorder
and as frontline providers, pharmacists encounter
patients with substance
use disorder on a daily basis.
And this is an area where practice
authority continues to evolve.
(01:28):
Did you know that in 11 states, pharmacists
now have authority
to prescribe controlled substances
through some mechanism,
whether it be a collaborative practice
agreement, statewide protocol,
or independent prescribing authority?
This includes medication for opioid use disorder,
and there are pharmacists
out there
taking the lead
and serving these patients in need.
(01:48):
In fact,
the National Association of Boards
of Pharmacy and National Community Pharmacies
Association, just published the pharmacy Access
to Resources
and medication for opioid use disorder
or PhARM OUD
guideline in collaboration
with the University of Houston
College of Pharmacy.
And that will be the topic of discussion
for today.
(02:09):
During part two,
I'll welcome
an expert in the field
who's really dedicated his life
to supporting patients
with substance use disorder
and educating pharmacists on how to do the same.
I can't wait to introduce you to him.
So let's dive into this publication,
which is designed to equip community
pharmacists with the essential tools
to help them enhance patient care.
(02:30):
The PhARM OUD guideline provides nine major
recommendations and 35 additional strategies
designed to eliminate confusion
and fear
surrounding the dispensing of buprenorphine.
While we won't have time
to review
all of these today,
We'll focus on a few
and certainly encourage
listeners to review the full publication.
So let's dive in.
(02:50):
Yara, can you give the listeners
a high level overview
of the nine core
recommendations that are included in the PhARM
OUD guidelines?
Of course,
the first recommendation maintenance
pharmacotherapy buprenorphine
suggests
that pharmacists should keep
an adequate supply
of buprenorphine in their pharmacies
and be ready to dispense it
to patients with opioid use disorder.
(03:11):
It also highlights that refusing to dispense
buprenorphine may disrupt treatment,
cause withdrawal
and heighten the risk of
opiate relapse and death.
The second recommendation
potential indicators of misuse or diversion
in prescription drug
monitoring programs
suggest that pharmacists should utilize, safe,
prescription drug
monitoring programs to inform their buprenorphine
(03:33):
dispensing decisions,
supplementing their clinical judgment
rather than replacing it.
The third recommendation, early refills
suggest that requests
for early refills of buprenorphine
should not automatically be viewed as misuse.
They may be due to legitimate reasons,
such as dosage adjustments
or changes in residence.
Before making a dispensing decision,
(03:53):
pharmacists should discuss the context
of the request with the patient,
contact the prescriber and document the rationale
for dispensing or declining the prescription.
The fourth recommendations, telehealth suggests
that pharmacists should dispense buprenorphine
prescriptions from telehealth providers
if the prescriptions are legitimate
and the pharmacist
can fulfill their corresponding responsibilities.
(04:15):
The fifth recommendation
Buprenorphine mono product.
This recommendation states
that current clinical evidence
supports the safety
and efficacy of the buprenorphine
mono product for the treatment
of opioid use disorder.
The six recommendation
Optimizing the safety
and effectiveness
of buprenorphine
pharmacotherapy suggests
that pharmacists and pharmacy
(04:36):
technicians should optimize
the quality of care for persons
prescribed buprenorphine.
We will discuss
more details about this recommendation later on.
The seventh recommendation
Care Coordination and Prescriber Communication.
Pharmacists can support patients
with opioid use disorder
by providing
comprehensive services like medication
management, immunizations,
(04:57):
implementing collaborative practice
agreements for therapy,
monitoring, promoting
adherence through referrals,
and ensuring direct communication
with prescribers.
Additionally,
they should consider dispensing
partial quantities of buprenorphine
when they can not promptly reach
a prescriber
to prevent care interruptions when needed.
The eighth recommendation Stigma towards persons
(05:18):
with opioid use disorder.
Pharmacy staff
should approach patients
with opioid use disorder
with empathy and compassion, actively recognizing
and addressing
their own biases to provide
patient centered care.
And the last recommendation,
the ninth Employer Oversight pharmacy policies
should promote
flexibility in buprenorphine dispensing,
(05:39):
allowing pharmacists
to exercise
a professional judgment
when making dispensing decisions.
Thanks so much, Yara.
That was a great overview
of the recommendations that are provided.
I want to take a little bit more closer
look at recommendations one,
six and eight specifically.
So Nick,
why don't you help me by reviewing
key points for pharmacists
(06:01):
related to recommendation
one Maintenance pharmacotherapy
with buprenorphine?
Of course.
Yeah.
So first,
it's important
to remember that opioid use
disorder is not a short term illness.
It's recovery is lifelong.
With buprenorphine,
there is no maximum safe duration
and no minimum effective duration of therapy.
What is known
(06:21):
is that there is an increase
in risk of morbidity and mortality
for treatment durations
for treatment episodes less than 180 days
and treatment durations longer than 365 days
show significant reductions in mortality.
The length of treatment
is entirely dependent
on the prescribers, clinical judgment
and the patient's individual circumstances.
(06:42):
Our role as pharmacists
is not to question the length of treatment,
but to support patient care and provide
lifesaving medication
throughout the needed treatment duration.
Secondly, I really want to talk about maintaining
an adequate supply.
A survey from 2022 found that
only 48% of nearly 6000 pharmacies
across 11 states were willing and able
(07:03):
to dispense a one week supply of buprenorphine.
We're talking much
longer durations of therapy here,
so we're gonna need more than a week at a time.
More recently, roughly
58% of a similar number of pharmacies reported
buprenorphine availability.
So the number is getting better,
but we're still not where we need to be.
Also, in 2022, the average dispensing
(07:23):
rate of buprenorphine was 4.8
prescriptions per 100 persons, which equals
roughly 16 million prescriptions
in that calendar year.
That number is held
pretty steady between 2019 and 2022,
and we're still kind of waiting
for more data from 2023 and 2024.
So this is all to say that it's important
to appropriately manage on hand supply
(07:44):
within the pharmacy
to prevent any disruptions
in patient care and management
of opioid use disorder.
And another point is
when you are dispensing buprenorphine,
you can still check the providers DEA number
if you think it's necessary
when filling that prescription.
However, you just won't see the X
before the providers the number going forward
as the MAT act eliminated that requirement.
(08:07):
If the patient has no contraindications
such as hypersensitivity to buprenorphine
and doesn't display
any signs of misuse or diversion.
You should feel pretty safe
to dispense the prescription.
What is the MAT Act, you might ask?
I know I just dropped the name there.
The MAT
Act is a
section of the Consolidated Appropriations
Act of 2023 that removed the waiver
(08:28):
requirement for prescribing
buprenorphine
for the treatment of opioid use disorder,
a concurrent act,
the Medication Access and Training
Expansion Act, or MATE Act
in the same bill requires new and renewing
DEA registrants to include
pharmacists, pharmacy
technicians, interns and assistants
and pharmacies in general, to have completed
(08:48):
at least 8 hours
of training on opioid
or other substance use disorders
as of June 27, 2023.
So if you're in the process of renewing,
make sure you get your hours
completed before you submit.
Thank you so much, Nick,
for talking about the importance of access
to long term maintenance, pharmacotherapy
and recent legislative action
that has been taken to accomplish this.
(09:08):
Now Yara, let's shift gears a bit
to how pharmacists and pharmacy
technicians can play a part
in optimizing the safety
and effectiveness of buprenorphine and review.
recommendation number six.
Of course, so as a reminder, recommendation
six optimize
the safety and effectiveness
of buprenorphine pharmacotherapy.
So this recommendation dives into ways
(09:29):
that both pharmacists and pharmacy
technicians can optimize the use of
and quality of care for persons
prescribed with buprenorphine.
Let's first talk about things pharmacists can do
so they can provide patient counseling
by informing patients about potential adverse
effects of buprenorphine
and encourage them to report
any adverse
events such as opioid induced constipation,
(09:49):
respiratory depression, dental cavities
and or tooth loss and increase in blood pressure.
They could also dispense naloxone
so they can offer
duloxetine to patients
prescribed buprenorphine
to manage a rare use disorder.
They can educate patients
on potential drug interactions, so patients
should be educated
about the risk of certain drug combinations,
(10:09):
such as for opiate agonist,
benzodiazepine, sedative
hypnotics and alcohol
use while taking buprenorphine.
And finally,
they can counsel patients on safe storage
and disposal.
Buprenorphine is stored at room temperature.
It should be protected from light
and kept out of reach of children.
The best disposal option
is for patients to find a drug,
(10:30):
take back location,
and if they don't have a drug,
take back location near them.
Buprenorphine can be flushed down the toilet.
Now let's shift gears to things pharmacy
technicians can do.
Technicians can enhance
care efficiency by assisting with tasks
such as accessing prescription
monitoring, program information,
contacting prescribers,
reminding patients
(10:50):
about refills and helping
with reimbursement at the pharmacy.
These are all ways on
how pharmacists and pharmacy techs
can optimize the use of
and quality of care for persons
prescribing buprenorphine.
Great. Thanks so much, Yara.
I personally found the call out
to involving pharmacy technicians
in the care of persons with OUD really impactful.
Pharmacy technicians play such a crucial role
(11:12):
in what we do as pharmacists,
and the guidelines had some great recommendations
for how they can get involved.
All right.
For the last topic of discussion
today, Nick,
why don't you review
recommendation eight for our listeners,
which focuses on
combating stigma towards persons with OUD?
Yeah, sure.
So I'll cover
just a few important recommendations
within the guidelines to promote an experience
(11:34):
free of stigma for patients.
But first,
I really want to mention the oath of
a pharmacist,
which is cited
directly with within the PhARM
OUD recommendations.
When we stated the oath,
we pledge to consider the welfare of humanity
and the relief of suffering
as our primary concern
by declining to fill legitimate prescriptions,
(11:55):
we are creating stigma
and continuing the suffering of patients in need,
which is entirely antithetical to that oath
that we all took in keeping with that pledge.
Pharmacists should not require patients
to transfer their non-controlled
prescriptions to their pharmacy
before dispensing buprenorphine.
This creates an unnecessary barrier to care
(12:15):
that may lead to a patient's reluctance
to seek help.
Another aspect to consider is that a patient
might have a routine source
of maintenance medication,
or that patients who are uninsured
or underinsured
are actively seeking the lowest cost medications
and forcing them to transfer
would be economically unwieldy and burdensome
for the patient.
We want our patients to feel
(12:36):
that they can come to us without
fear of stigma or rejection.
We also want to move away
from requiring patient interviews prior
to dispensing buprenorphine,
asking why a patient is filling a medication
or attempting to discern
if a patient is likely to misuse
or divert that medication
via subjective questions
can be seen as an attempt to deny care
(12:57):
and lead
to that patient
feeling stigmatized to a degree
in which they no longer view treatment
as available.
However, if necessary, to clarify
potential indicators of misuse
or diversion, pharmacists
should be direct and transparent
about why they are asking for further information
from the patient.
It is important to note that buprenorphine misuse
(13:19):
only occurs in roughly one
fourth of patients who take it,
and that diversion of buprenorphine rate
is actually lower than misuse rates at about 17%.
Finally, everyone in the pharmacy
can and should act
with empathy towards
those with substance use disorder
or opioid use disorder
and treat them with the same dignity and respect
as you treat every other patient with.
(13:40):
This can be as simple as how we talk to patients.
We can ask
if the patient is all right
with questions about their opioid use
disorder and treatment.
We can reassure them that the discussion,
while uncomfortable,
is normal and necessary to help them.
And as I said earlier,
just treat them with the same respect
as you would give any patient in your pharmacy.
Thank you, Nick.
(14:00):
And you are for providing
such valuable insights
into the recent PhARM OUD guidelines,
which are a great example
of how pharmacists impact public health.
We're going to dig into recommendation
eight in a bit more detail
next week on our episode,
where I'll speak with Jake Nichols,
a pharmacist
with committed his life
to serving patients
with OUD in an environment
(14:21):
for stigma
and educating others about how to do so.
So let's summarize key
takeaways from our time here today.
First, pharmacists and pharmacy technicians
are crucial providers
in ensuring access to buprenorphine
and to manage their inventory
and dispensing in order to do so.
Pharmacists can provide patients
with education
about proper use, storage and adverse events
(14:44):
and pharmacy technicians
can help with prescription monitoring,
refill reminders and reimbursement
When serving patients with SUD,
care should be taken to avoid processes
like required transfers
or interviews that create unnecessary
barriers to access.
We'll talk more about stigma next week as well.
All right, folks,
that's all the time we have here for today.
(15:06):
Look out for part
two of this month's first Fill podcast
that will release next Thursday.
For any listeners
who practice in those states
that I mentioned
that have authority
to prescribe
MOUD, APhA has an eight hour training program
on initiating buprenorphine that meets MATE
Act training requirements.
Definitely check that out.
If you're looking to renew your license
(15:26):
or become a provider to support persons with OUD.
And last but not least,
don't forget to head over to the Learning Library
at learn.pharmacist.com
to earn your CE for this month's podcast.
We'd love to hear your feedback
on how you like this new set up.
Thanks so much and take care.
Welcome to the First Fill and happy
American Pharmacists month.
With it being American Pharmacists month,
we thought it was really important
to focus on the critical role
the pharmacist plays
in improving outcomes in public health
from serving as a vital community resource,
delivering hundreds of thousands of vaccines
to ensuring patients are on the right antibiotic
at the right dose for a life
(00:22):
threatening infection.
You as pharmacists play such an essential role
for your patients.
So thank you for all that you do.
Before we dive
in, I'd like to introduce my guests today
APhA executive fellows Nick and Yara.
Nick and Yara,
why don't you introduce yourselves?
Yeah. So.
Hi, I'm Nick,
one of the executive fellows in education.
(00:45):
Happy to be here.
Happy to get started on this.
Hello, I'm Yara
Al Shaer, and the other education fellow here.
All right.
Thanks, Nick and Yara for that.
More specifically,
this month,
we're going to focus on the great work
pharmacists are doing to support
patients with substance use disorder.
According to a 2022 national survey
on drug use and health
(01:06):
data released by HHS and SAMHSA,
48.7 million people aged 12 and older,
or 17.4% of the US population had a substance
use disorder
and as frontline providers, pharmacists encounter
patients with substance
use disorder on a daily basis.
And this is an area where practice
authority continues to evolve.
(01:28):
Did you know that in 11 states, pharmacists
now have authority
to prescribe controlled substances
through some mechanism,
whether it be a collaborative practice
agreement, statewide protocol,
or independent prescribing authority?
This includes medication for opioid use disorder,
and there are pharmacists
out there
taking the lead
and serving these patients in need.
(01:48):
In fact,
the National Association of Boards
of Pharmacy and National Community Pharmacies
Association, just published the pharmacy Access
to Resources
and medication for opioid use disorder
or PhARM OUD
guideline in collaboration
with the University of Houston
College of Pharmacy.
And that will be the topic of discussion
for today.
(02:09):
During part two,
I'll welcome
an expert in the field
who's really dedicated his life
to supporting patients
with substance use disorder
and educating pharmacists on how to do the same.
I can't wait to introduce you to him.
So let's dive into this publication,
which is designed to equip community
pharmacists with the essential tools
to help them enhance patient care.
(02:30):
The PhARM OUD guideline provides nine major
recommendations and 35 additional strategies
designed to eliminate confusion
and fear
surrounding the dispensing of buprenorphine.
While we won't have time
to review
all of these today,
We'll focus on a few
and certainly encourage
listeners to review the full publication.
So let's dive in.
(02:50):
Yara, can you give the listeners
a high level overview
of the nine core
recommendations that are included in the PhARM
OUD guidelines?
Of course,
the first recommendation maintenance
pharmacotherapy buprenorphine
suggests
that pharmacists should keep
an adequate supply
of buprenorphine in their pharmacies
and be ready to dispense it
to patients with opioid use disorder.
(03:11):
It also highlights that refusing to dispense
buprenorphine may disrupt treatment,
cause withdrawal
and heighten the risk of
opiate relapse and death.
The second recommendation
potential indicators of misuse or diversion
in prescription drug
monitoring programs
suggest that pharmacists should utilize, safe,
prescription drug
monitoring programs to inform their buprenorphine
(03:33):
dispensing decisions,
supplementing their clinical judgment
rather than replacing it.
The third recommendation, early refills
suggest that requests
for early refills of buprenorphine
should not automatically be viewed as misuse.
They may be due to legitimate reasons,
such as dosage adjustments
or changes in residence.
Before making a dispensing decision,
(03:53):
pharmacists should discuss the context
of the request with the patient,
contact the prescriber and document the rationale
for dispensing or declining the prescription.
The fourth recommendations, telehealth suggests
that pharmacists should dispense buprenorphine
prescriptions from telehealth providers
if the prescriptions are legitimate
and the pharmacist
can fulfill their corresponding responsibilities.
(04:15):
The fifth recommendation
Buprenorphine mono product.
This recommendation states
that current clinical evidence
supports the safety
and efficacy of the buprenorphine
mono product for the treatment
of opioid use disorder.
The six recommendation
Optimizing the safety
and effectiveness
of buprenorphine
pharmacotherapy suggests
that pharmacists and pharmacy
(04:36):
technicians should optimize
the quality of care for persons
prescribed buprenorphine.
We will discuss
more details about this recommendation later on.
The seventh recommendation
Care Coordination and Prescriber Communication.
Pharmacists can support patients
with opioid use disorder
by providing
comprehensive services like medication
management, immunizations,
(04:57):
implementing collaborative practice
agreements for therapy,
monitoring, promoting
adherence through referrals,
and ensuring direct communication
with prescribers.
Additionally,
they should consider dispensing
partial quantities of buprenorphine
when they can not promptly reach
a prescriber
to prevent care interruptions when needed.
The eighth recommendation Stigma towards persons
(05:18):
with opioid use disorder.
Pharmacy staff
should approach patients
with opioid use disorder
with empathy and compassion, actively recognizing
and addressing
their own biases to provide
patient centered care.
And the last recommendation,
the ninth Employer Oversight pharmacy policies
should promote
flexibility in buprenorphine dispensing,
(05:39):
allowing pharmacists
to exercise
a professional judgment
when making dispensing decisions.
Thanks so much, Yara.
That was a great overview
of the recommendations that are provided.
I want to take a little bit more closer
look at recommendations one,
six and eight specifically.
So Nick,
why don't you help me by reviewing
key points for pharmacists
(06:01):
related to recommendation
one Maintenance pharmacotherapy
with buprenorphine?
Of course.
Yeah.
So first,
it's important
to remember that opioid use
disorder is not a short term illness.
It's recovery is lifelong.
With buprenorphine,
there is no maximum safe duration
and no minimum effective duration of therapy.
What is known
(06:21):
is that there is an increase
in risk of morbidity and mortality
for treatment durations
for treatment episodes less than 180 days
and treatment durations longer than 365 days
show significant reductions in mortality.
The length of treatment
is entirely dependent
on the prescribers, clinical judgment
and the patient's individual circumstances.
(06:42):
Our role as pharmacists
is not to question the length of treatment,
but to support patient care and provide
lifesaving medication
throughout the needed treatment duration.
Secondly, I really want to talk about maintaining
an adequate supply.
A survey from 2022 found that
only 48% of nearly 6000 pharmacies
across 11 states were willing and able
(07:03):
to dispense a one week supply of buprenorphine.
We're talking much
longer durations of therapy here,
so we're gonna need more than a week at a time.
More recently, roughly
58% of a similar number of pharmacies reported
buprenorphine availability.
So the number is getting better,
but we're still not where we need to be.
Also, in 2022, the average dispensing
(07:23):
rate of buprenorphine was 4.8
prescriptions per 100 persons, which equals
roughly 16 million prescriptions
in that calendar year.
That number is held
pretty steady between 2019 and 2022,
and we're still kind of waiting
for more data from 2023 and 2024.
So this is all to say that it's important
to appropriately manage on hand supply
(07:44):
within the pharmacy
to prevent any disruptions
in patient care and management
of opioid use disorder.
And another point is
when you are dispensing buprenorphine,
you can still check the providers DEA number
if you think it's necessary
when filling that prescription.
However, you just won't see the X
before the providers the number going forward
as the MAT act eliminated that requirement.
(08:07):
If the patient has no contraindications
such as hypersensitivity to buprenorphine
and doesn't display
any signs of misuse or diversion.
You should feel pretty safe
to dispense the prescription.
What is the MAT Act, you might ask?
I know I just dropped the name there.
The MAT
Act is a
section of the Consolidated Appropriations
Act of 2023 that removed the waiver
(08:28):
requirement for prescribing
buprenorphine
for the treatment of opioid use disorder,
a concurrent act,
the Medication Access and Training
Expansion Act, or MATE Act
in the same bill requires new and renewing
DEA registrants to include
pharmacists, pharmacy
technicians, interns and assistants
and pharmacies in general, to have completed
(08:48):
at least 8 hours
of training on opioid
or other substance use disorders
as of June 27, 2023.
So if you're in the process of renewing,
make sure you get your hours
completed before you submit.
Thank you so much, Nick,
for talking about the importance of access
to long term maintenance, pharmacotherapy
and recent legislative action
that has been taken to accomplish this.
(09:08):
Now Yara, let's shift gears a bit
to how pharmacists and pharmacy
technicians can play a part
in optimizing the safety
and effectiveness of buprenorphine and review.
recommendation number six.
Of course, so as a reminder, recommendation
six optimize
the safety and effectiveness
of buprenorphine pharmacotherapy.
So this recommendation dives into ways
(09:29):
that both pharmacists and pharmacy
technicians can optimize the use of
and quality of care for persons
prescribed with buprenorphine.
Let's first talk about things pharmacists can do
so they can provide patient counseling
by informing patients about potential adverse
effects of buprenorphine
and encourage them to report
any adverse
events such as opioid induced constipation,
(09:49):
respiratory depression, dental cavities
and or tooth loss and increase in blood pressure.
They could also dispense naloxone
so they can offer
duloxetine to patients
prescribed buprenorphine
to manage a rare use disorder.
They can educate patients
on potential drug interactions, so patients
should be educated
about the risk of certain drug combinations,
(10:09):
such as for opiate agonist,
benzodiazepine, sedative
hypnotics and alcohol
use while taking buprenorphine.
And finally,
they can counsel patients on safe storage
and disposal.
Buprenorphine is stored at room temperature.
It should be protected from light
and kept out of reach of children.
The best disposal option
is for patients to find a drug,
(10:30):
take back location,
and if they don't have a drug,
take back location near them.
Buprenorphine can be flushed down the toilet.
Now let's shift gears to things pharmacy
technicians can do.
Technicians can enhance
care efficiency by assisting with tasks
such as accessing prescription
monitoring, program information,
contacting prescribers,
reminding patients
(10:50):
about refills and helping
with reimbursement at the pharmacy.
These are all ways on
how pharmacists and pharmacy techs
can optimize the use of
and quality of care for persons
prescribing buprenorphine.
Great. Thanks so much, Yara.
I personally found the call out
to involving pharmacy technicians
in the care of persons with OUD really impactful.
Pharmacy technicians play such a crucial role
(11:12):
in what we do as pharmacists,
and the guidelines had some great recommendations
for how they can get involved.
All right.
For the last topic of discussion
today, Nick,
why don't you review
recommendation eight for our listeners,
which focuses on
combating stigma towards persons with OUD?
Yeah, sure.
So I'll cover
just a few important recommendations
within the guidelines to promote an experience
(11:34):
free of stigma for patients.
But first,
I really want to mention the oath of
a pharmacist,
which is cited
directly with within the PhARM
OUD recommendations.
When we stated the oath,
we pledge to consider the welfare of humanity
and the relief of suffering
as our primary concern
by declining to fill legitimate prescriptions,
(11:55):
we are creating stigma
and continuing the suffering of patients in need,
which is entirely antithetical to that oath
that we all took in keeping with that pledge.
Pharmacists should not require patients
to transfer their non-controlled
prescriptions to their pharmacy
before dispensing buprenorphine.
This creates an unnecessary barrier to care
(12:15):
that may lead to a patient's reluctance
to seek help.
Another aspect to consider is that a patient
might have a routine source
of maintenance medication,
or that patients who are uninsured
or underinsured
are actively seeking the lowest cost medications
and forcing them to transfer
would be economically unwieldy and burdensome
for the patient.
We want our patients to feel
(12:36):
that they can come to us without
fear of stigma or rejection.
We also want to move away
from requiring patient interviews prior
to dispensing buprenorphine,
asking why a patient is filling a medication
or attempting to discern
if a patient is likely to misuse
or divert that medication
via subjective questions
can be seen as an attempt to deny care
(12:57):
and lead
to that patient
feeling stigmatized to a degree
in which they no longer view treatment
as available.
However, if necessary, to clarify
potential indicators of misuse
or diversion, pharmacists
should be direct and transparent
about why they are asking for further information
from the patient.
It is important to note that buprenorphine misuse
(13:19):
only occurs in roughly one
fourth of patients who take it,
and that diversion of buprenorphine rate
is actually lower than misuse rates at about 17%.
Finally, everyone in the pharmacy
can and should act
with empathy towards
those with substance use disorder
or opioid use disorder
and treat them with the same dignity and respect
as you treat every other patient with.
(13:40):
This can be as simple as how we talk to patients.
We can ask
if the patient is all right
with questions about their opioid use
disorder and treatment.
We can reassure them that the discussion,
while uncomfortable,
is normal and necessary to help them.
And as I said earlier,
just treat them with the same respect
as you would give any patient in your pharmacy.
Thank you, Nick.
(14:00):
And you are for providing
such valuable insights
into the recent PhARM OUD guidelines,
which are a great example
of how pharmacists impact public health.
We're going to dig into recommendation
eight in a bit more detail
next week on our episode,
where I'll speak with Jake Nichols,
a pharmacist
with committed his life
to serving patients
with OUD in an environment
(14:21):
for stigma
and educating others about how to do so.
So let's summarize key
takeaways from our time here today.
First, pharmacists and pharmacy technicians
are crucial providers
in ensuring access to buprenorphine
and to manage their inventory
and dispensing in order to do so.
Pharmacists can provide patients
with education
about proper use, storage and adverse events
(14:44):
and pharmacy technicians
can help with prescription monitoring,
refill reminders and reimbursement
When serving patients with SUD,
care should be taken to avoid processes
like required transfers
or interviews that create unnecessary
barriers to access.
We'll talk more about stigma next week as well.
All right, folks,
that's all the time we have here for today.
(15:06):
Look out for part
two of this month's first Fill podcast
that will release next Thursday.
For any listeners
who practice in those states
that I mentioned
that have authority
to prescribe
MOUD, APhA has an eight hour training program
on initiating buprenorphine that meets MATE
Act training requirements.
Definitely check that out.
If you're looking to renew your license
(15:26):
or become a provider to support persons with OUD.
And last but not least,
don't forget to head over to the Learning Library
at learn.pharmacist.com
to earn your CE for this month's podcast.
We'd love to hear your feedback
on how you like this new set up.
Thanks so much and take care.
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