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Pharmacy professionals’ role in addictions

 
 

Opioid Guidelines introduced

With no signs of Alberta’s opioid crisis slowing down, ACP introduced new guidelines for assessing individuals using opioid medications. The guidelines are based on the existing Standards of Practice for Pharmacists and Pharmacy Technicians, and provide clarity and context specific to opioids. The guidelines, which came into effect October 1, 2017, include five key requirements:

  1. Pharmacists must establish and maintain a professional relationship with each individual using opioid medications.
  2. Pharmacists must complete a thorough assessment of each individual who is prescribed opioid medications or sold an exempted codeine product.  
    • This assessment must include a review of the Electronic Health Record (Netcare) every time a prescription for an opioid medication is dispensed or sold.
  3. Pharmacists must document details of the assessment in the patient record of care and develop a written treatment plan for individuals using long-term opioid therapy or for those determined to be at high risk of misuse or addiction. 
  4. Pharmacists must collaborate with the prescriber and other healthcare professionals involved in the care of individuals using opioid medications.
  5. Pharmacists and pharmacy technicians must monitor individuals for the signs of opioid misuse, diversion, or addiction and take appropriate action.

Even though they are based on existing standards, the opioid guidelines proved to be an adjustment for both pharmacists and individuals who use opioid medications. ACP has encouraged pharmacy professionals to be empathetic, reduce stigmatization, and use their professional judgement when conducting assessments. Albertans should always expect their pharmacist to assess the appropriateness of any medication they’ve been prescribed, opioid or otherwise. 

ACP also supported a request from the Alberta Medical Association to promote improved access to non-drug alternatives for pain management. It’s hoped improved access to therapies and services that have evidence-based support can help prevent patients from requiring long-term opioid therapy.

As the most accessible healthcare professionals, pharmacists are well positioned to make a positive difference in the opioid crisis, one interaction at a time. 

 

Alberta’s Community Based Naloxone Program

2017 saw many changes to Alberta’s Community Based Naloxone Program. In February, Naloxone became an unscheduled drug in Alberta, meaning that it may be available in locations other than pharmacies. Recognizing this, ACP updated its Naloxone guidelines to accommodate the provision of Overdose Response Kits by pharmacy technicians and pharmacy assistants.

Once pharmacy technicians and pharmacy assistants have received the appropriate training, they are eligible to train individuals how to self-administer Naloxone. It is the responsibility of pharmacy licensees (pharmacists who oversee practice within a pharmacy) to ensure their staff are appropriately trained and perform consistently within ACP’s guidelines, the Standards of Practice, and the Code of Ethics.

Codeine

ACP has actively supported an initiative to move non-prescription drugs containing codeine to prescription status. Some medications containing codeine include pain medication, muscle relaxants, and cough suppressants. 

All drugs, whether accessed by prescription or not, have risks associated with them, including those products containing codeine. 

Despite evidence that demonstrates the lack of efficacy for these products, and despite other countries rescheduling these products to make them less accessible, Alberta’s government has not supported this policy direction, for fear that those seeking nonprescription codeine preparations may default to riskier behaviours.

Triplicate Prescription Program

ACP is a partner in the Triplicate Prescription Program (TPP) which was established in 1986. The TPP mandate is

  • to monitor prescribing, dispensing, and utilization practices regarding targeted medications; 
  • to improve patient care by providing relevant information and feedback on targeted drugs to prescribers and pharmacists; 
  • to provide timely and relevant information on targeted medications to consumers, regulatory bodies, and stakeholders; 
  • to work with stakeholders to enable system level change that ensure appropriate use of targeted medications; and
  • to ensure efficient and effective functioning of the TPP program. 

In 2017, due to the potential risk of abuse, misuse, and diversion, the TPP added tramadol and stimulants (mixed amphetamine salts, dextroamphetamine, and lisdexamfetamine) to the list of TPP medications to be monitored.