Engaging Pharmacists as Partners in Opioid Harm Reduction

Practitioners’ Role: Safe Opioid Prescribing and Misuse

Southern Kentucky AHECJuly 11, 2019

Trish Freeman, PhD, RPh

Faculty Disclosure

• Dr. Freeman has nothing to disclose

Practice Gap• Pharmacists are highly-trained and accessible

health care providers who positively impact public health, but who are often underutilized in the area of opioid harm reduction

• Pharmacists in Kentucky have not traditionally been involved in opioid harm reduction activities and need information on the positive impact and potential role they can play

Educational Need

Learning Objectives

• Upon completion of this activity, participants will be able to:– Describe the role of the pharmacist in opioid harm

reduction, including naloxone provision– Identify the impact pharmacists have had on

increasing naloxone access and reducing opioid overdose mortality

Expected Outcomes

• Increased pharmacist understanding of the role they can play in opioid harm reduction

• Increased pharmacist participation in opioid harm reduction activities

Pharmacists as Partners in Public Health

• Unparalleled accessibility in communities– >90% of US population lives within 5 miles of a pharmacy

• Documented impact in public health through increased vaccination rates

• Untapped potential to impact public health in other areas• Recent efforts focused on role in harm reduction

The Problem of Opioid Overdose

The Problem of Opioid Overdose

Estimates are preliminary and subject to revisionSource: CDC WAPO.ST/WONKBLOG

Drug overdose deaths per 100,000 in 2017

Naloxone

• Pure opioid antagonist• Competes for mu, kappa, and

sigma opiate receptor sites within the CNS

• When administered alone, has no pharmacological activity

Adapted from: http://www.copeaustralia.com.au/naloxone/Naloxone hydrochloride Injection, USP [package insert]. Lake Forest, IL: Hospira; 2007.Evzio® Auto-Injector [package insert] Richmond, VA: kaleo;2014.

http://www.copeaustralia.com.au/naloxone/

https://actionindahlonega.files.wordpress.com/2015/04/narcan-with-needle3.jpghttp://www.scancrit.com/wp-content/uploads/2011/11/MAD100-2-300x163.jpghttps://pbs.twimg.com/media/BtPSd7JCIAASOw4.png

https://actionindahlonega.files.wordpress.com/2015/04/narcan-with-needle3.jpghttp://www.scancrit.com/wp-content/uploads/2011/11/MAD100-2-300x163.jpghttps://pbs.twimg.com/media/BtPSd7JCIAASOw4.png

Expansion of Naloxone Access Laws, 2013 - 2017

http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139

http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139

Expansion of Pharmacist-Based Naloxone Laws, 2013 - 2017

http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139

http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139

Using Law to Support Pharmacy Naloxone Distribution

• Pharmacist prescribing (7)

• Dispensing via standing order (42)

• Dispensing via state-wide protocol (14)

• Dispensing via collaborative practice agreements (6)https://www.networkforphl.org/_asset/qdkn97/Pharmacy-Naloxone-Distributions.pdf

https://www.networkforphl.org/_asset/qdkn97/Pharmacy-Naloxone-Distributions.pdf

KY SB 192 (2015)

• Comprehensive legislation passed in 2015 session– Increased access to treatment– Authorized needle exchange program– Good Samaritan clause– Increased access to naloxone

Journal of the American Pharmacists Association Volume 57, Issue 2, Pages S28-S33 (March 2017) ]

n=843

Perceived BarriersWhich of the following are barriers that you foresee in implementing a naloxone access program at your practice? (check all that apply) n=843

Response Frequency % of All RespondentsTime to develop and implement program 505 59.9%Support from manager or administration for program 229 27.2%Knowledge regarding the law and regulations authorizing naloxone access programs 406 48.2%

Complications with billing and reimbursement 419 49.7%Moral or ethical concerns associated with drug abuse and overdose 214 25.4%

Concerns over clientele that might frequent the pharmacy if a program were in place 408 48.4%

Packaging or stocking the various forms of naloxone 155 18.9%Community opposition to a local naloxone access program 143 17%

Other barriers (please describe)* 45 5.3%None of these are barriers 25 3.0%

Journal of the American Pharmacists AssociationVolume 57, Issue 2, Pages S28-S33 (March 2017)

Impact to Date• Over 20 training programs held across

the state between June 28, 2015 and July 2017– Over 2000 pharmacists and 800 student

pharmacists trained• To-date, over 2500 pharmacists certified

by Board of Pharmacy to initiate dispensing of naloxone

• Protocols in place across the state at close to 400 independent and chain community pharmacies

https://odcp.ky.gov/Stop-Overdoses/Pages/Locations.aspx

How has naloxone dispensing changed as a result of policy

interventions?

Freeman et al, Drug and Alcohol Dependence Vol. 191:361-364, 2018

Freeman et al, Drug and Alcohol Dependence Vol. 191:361-364, 2018

New Approaches to Increase Naloxone Access

Naloxone co-prescription laws

– VA, VT (2017)– AZ, CA, RI (2018)

Conclusion: Although many states have passed some type of law affecting naloxone availability, only laws allowing direct dispensing by pharmacists appear to be useful. Communities in which access to naloxone is improved should prepare for increases in nonfatal overdoses and link these individuals to effective treatment.

• HIV/Hep C testing?• Treatment of opioid use disorder?• Disposal?• SBIRT?

Other Roles for Pharmacists in Opioid-related Harm Reduction

Questions?

Engaging Pharmacists as Partners in Opioid Harm ReductionFaculty DisclosurePractice GapLearning ObjectivesExpected OutcomesPharmacists as Partners in Public HealthThe Problem of Opioid OverdoseThe Problem of Opioid OverdoseNaloxoneSlide Number 10Expansion of Naloxone Access Laws, 2013 - 2017Expansion of Pharmacist-Based Naloxone Laws, 2013 - 2017Using Law to Support Pharmacy Naloxone DistributionKY SB 192 (2015) Slide Number 15Perceived BarriersImpact to DateHow has naloxone dispensing changed as a result of policy interventions?Slide Number 19Slide Number 20New Approaches to Increase �Naloxone AccessSlide Number 22Slide Number 23Slide Number 24Slide Number 25Other Roles for Pharmacists in Opioid-related Harm ReductionQuestions?