28 Operations & Management
Pharmacy Practice News • May 2022
Collaborative Care
Pharmacists Can Be OUD Experts and Combat Abuse By Dave Doolittle and Bob Kronemyer
H
ealth-system pharmacists should continue to play a major role in the treatment of people with opioid use disorder (OUD), particularly patients on long-term buprenorphine therapy. That’s why ASHP was involved recently in a joint venture of several health societies that developed recommendations on how to boost use of the
opioid partial agonist after surgery and before discharge for patients with OUD. The recommendations, published in Regional Anesthesia & Pain Medicine (2021;46[10]:840-859), are intended to be an educational resource for anesthesiologists and pain physicians but can be used by anyone on the care team, according to its developers. The American Society of Regional Anesthesia and Pain Medicine (ASRA) led
100,000 deaths have been attributed to opioid use over the past
12 months
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the venture along with ASHP, American Society of Anesthesiologists, American Academy of Pain Medicine and American Society of Addiction Medicine. “ASHP advocates for a collaborative approach to pain management and ensuring access to care across all care settings and for patients across the continuum of opioid prescribing, including prevention, treatment and supportive therapy,” Sophia Chhay, PharmD, an assistant
director off th ASHP Center, direc ctor o ct thee AS SHP HP IInnovation nnov nn ovat ovat atiio atio on Ce C en ntter ter er, Bethesda, Md., Pharmacy Practice in Bet ethe et the hesd sd da, M d.., told d told to d Ph P Phar harma arma ar acyy P raccttic ra tic ice News. ASHP New ws. “Moreover, “M Mor o eo oveer, r, A SH SHP HP ad aadvocates dvoc voccaate vo tess fo ffor or a sh shared model that puts har ared ed decision dec e isio issio i n m mo od deel tth hat at p utts th tthe he patient decisions.” patie een n ntt at a tthe he ccenter ente en ter of of ccare aarrree de d ecis ciissiion ons.” s.” s.
A Challenge Ch hal a leng le eng ge F Fr From ro om mF Former orm or rme mer Surgeon Surg geo on Ge G General en ne era er ral al Jerome Jero ro rome ome m Adams, Ada dams ms, MD M MD, D, MP M MPH, PH, H, ssparked parrk pa keed d tthe he he review off th during rre view ew w o tthe he re rrecommendations ecco comm mmen enda dati tio on ns d du urriin ngg ASRA 2019 meeting, where tthee A th SRA RA A sspring priin pr pri ng 20 2 019 19 m eeti ee eeti ting ngg,, w wh h her eerre he, surgeon was h e, a former form meerr U.S. U.S .S.. su urge rggeo eon general, geeneera ral,l, w aass Adams, course, spoke a speaker. speeaker.. “Dr.. Ad Adam dam ams, s, of of co cou ursee, sp ur pok ke opioid crisis and his aabout boutt the o pioid d cri isi siss an nd hi h is in is iinitiatives,” nittiaati tivvees, s” R. Vi Viscusi, MD, the senior ssaid aid Eugene R iscusi iscu cu ussii MD M D th he se eni nio orr author of the recommendations and an immediate past president of ASRA. “We started talking about the specific role of anesthesiologists and pain physicians in addressing the opioid crisis.” Dr. Viscusi and his colleagues shared some of their clinical initiatives and research in this area with Dr. Adams. “Dr. Adams essentially challenged me to produce some sort of initiative that would spur anesthesiologists to embrace their role in treating patients with OUD and to help initiate buprenorphine, specifically in these patients, when they enter the perioperative arena,” said Dr. Viscusi, the chief of pain medicine and a professor of anesthesiology at Sidney Kimmel Medical College of Thomas Jefferson University, in Philadelphia. In the case of a patient admitted to the hospital with a complication from addiction, such as infection, the recommendations support transitioning the patient from the use of standard opioids to buprenorphine after surgery and before discharge. The recommendations detail an approach that can be relatively easily accomplished without causing opioid withdrawal, assuming the patient is interested in treatment. For example, starting buprenorphine can be considered “for postoperative analgesia in patients with suspected OUD, using available social work or ancillary services to help facilitate linkage to outpatient buprenorphine prescribers when possible,” the recommendations state. Additionally, “in circumstances in which a warm hand-off has not been definitely established, the amount of buprenorphine prescribed can be consistent with appropriate postoperative discharge standards; however, a longer course of treatment could be provided, depending on the prescribing physician’s comfort level.” The other scenario is patients in drug addiction recovery currently on buprenorphine, for whom the recommendations advocate continuing the medicine during hospitalization and after discharge without interruption.
