Moving opioid misuse prevention upstream: A pilot study of community pharmacists screening for opioid misuse risk.

Abstract

Prescription opioids are known to be highly addictive, contributing to the opioid epidemic which continues to besiege victims in the United States. Pharmacists are gatekeepers straddling the prescribers of opioids and their patients; therefore they are in the ideal position to screen for opioid misuse among patients receiving opioid prescriptions and counsel them on safe use. The purpose of this study was to design the Opioid Misuse Risk Prevention Toolkit and then evaluate the utility of the toolkit by implementing it in community pharmacy practice sites. A critical element of the toolkit was the use of the Opioid Risk Tool (ORT) to screen all patients receiving opioid prescriptions for opioid use disorder. Eleven pharmacists were trained in the use of the toolkit, which they implemented within their community pharmacy for all patients receiving opioid prescriptions. A triage tool was used to guide the process of screening patients for opioid use disorder, red flags (patient unknown to the pharmacy, history of early refills, requesting a particular brand, or cash paying), risk of accidental overdose, and misuse of opioids through the prescription drug monitoring program (PDMP). Pharmacist-provided services included naloxone prescribing, counseling on opioid addiction risks, partial fills of opioid prescriptions, education on medication takeback programs, and referral information for community resources for patients concerned about a substance misuse disorder. Twenty-six percent of individuals (n = 107) receiving opioid prescriptions were identified as at some risk of misuse and 30% at risk of an accidental overdose. Participating pharmacists preferred the value of having an objective measurement of potential of opioid misuse, to relying only on professional judgment. They also reported the value of the toolkit elements in enhancing conversations with patients. This case report demonstrated the utility and the feasibility of screening for opioid misuse risk at the community pharmacy level.