Safe Opioid Use Research Articles

Nonmedical Opioid Use After Short-term Therapeutic Exposure in Children: A Systematic Review

Opioid-related harms continue to rise for children and youth. Analgesic prescribing decisions are challenging because the risk for future nonmedical opioid use or disorder is unclear. To synthesize research examining the association between short-term therapeutic opioid exposure and future nonmedical opioid use or opioid use disorder and associated risk factors. We searched 11 electronic databases. Two reviewers screened studies. Studies were included if: they were published in English or French, participants had short-term (≤14 days) or an unknown duration of therapeutic exposure to opioids before 18 years, and reported opioid use disorder or misuse. Data were extracted, and methodologic quality was assessed by 2 reviewers. Data were summarized narratively. We included 21 observational studies (49 944 602 participants). One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse; 4 showed an association between medical and nonmedical opioid use without specifying duration of exposure. Other studies reported on prevalence or incidence of nonmedical use after medical exposure to opioids. Risk factors were contradictory and remain unclear. Most studies did not specify duration of exposure and were of low methodologic quality, and participants might not have been opioid naïve. Some studies suggest an association between lifetime therapeutic opioid use and nonmedical opioid use. Given the lack of clear evidence regarding short-term therapeutic exposure, health care providers should carefully evaluate pain management options and educate patients and caregivers about safe, judicious, and appropriate use of opioids and potential signs of misuse.

A safe in-home disposal system with every opioid prescription? Food and Drug Administration is considering a potential new Risk Evaluation and Mitigation Strategy that could impact pharmacists

Misuse of prescription opioids contributes to the ongoing crisis of opioid-related overdose and deaths in the United States. The failure of patients and caregivers to safely dispose of unused opioids contributes to the problems. In 2018, Public Law 115-271 provided U.S. Food and Drug Administration (FDA) authority to mandate a Risk Evaluation and Mitigation Strategy (REMS) for safe disposal packaging or safe disposal solutions for opioid analgesic medications. FDA has been collaborating with stakeholders to determine whether a new REMS is needed. A new or revised opioid REMS could substantially affect opioid packaging, pharmacist roles and services, and dispensing activities such as education, counseling, and product distribution. The pharmacy profession has provided limited input to FDA regarding a potential new or revised opioid REMS. In this commentary, we aim to (1) provide awareness and raise questions on pertinent issues regarding opioid use and safe home disposal, (2) offer considerations for regulators on needed research in the development and assessment of a new REMS, and (3) highlight actions for pharmacist engagement in patient care services to promote safe use and safe home disposal of opioids. Consideration of a potential mandate regarding enhanced safety packaging or safe disposal solutions for opioids presents opportunities to revisit professional roles and engage proactively with FDA and other stakeholders. We hope this commentary stimulates timely feedback by pharmacy leaders, researchers, and practitioners on whether and how options for safe home disposal of opioids should be included in a REMS in contemplation of potential benefits, unintended consequences, expanded professional roles, timeline, assessment of program effectiveness, and adequate compensation. We support a shared opioid REMS that funds the counseling of patients and caregivers on safe opioid use and safe home opioid disposal options and provides appropriate education and products to facilitate that disposal.

Opioid Use and Its Relationship to Cardiovascular Disease and Brain Health: A Presidential Advisory From the American Heart Association

The misuse of opioids continues to be epidemic, resulting in dependency and a recent upsurge in drug overdoses that have contributed to a significant decrease in life expectancy in the United States. Moreover, recent data suggest that commonly used opioids for the management of pain may produce undesirable pharmacological actions and interfere with critical medications commonly used in cardiovascular disease and stroke; however, the impact on outcomes remains controversial. The American Heart Association developed an advisory statement for health care professionals and researchers in the setting of cardiovascular and brain health to synthesize the current literature, to provide approaches for identifying patients with opioid use disorder, and to address pain management and overdose. A literature and internet search spanning from January 1, 2012, to February 15, 2021, and limited to epidemiology studies, reviews, consensus statements, and guidelines in human subjects was conducted. Suggestions and considerations listed in this document are based primarily on published evidence from this review whenever possible, as well as expert opinion. Several federal and institutional consensus documents and clinical resources are currently available to both patients and clinicians; however, none have specifically addressed cardiovascular disease and brain health. Although strategic tools and therapeutic approaches for recognition of opioid use disorder and safe opioid use are available for health care professionals who manage patients with cardiovascular disease and stroke, high-quality evidence does not currently exist. Therefore, there is an urgent need for more research to identify the most effective approaches to improve care for these patients.

Multimodal opioid sparing onco-anesthesia: A consensus practice guideline from Society of Onco-Anesthesia and Perioperative Care (SOAPC).

Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thoracic, abdominal, pelvic, and lower limb surgeries and use of regional nerve blocks/catheter in head neck, neuro, and upper limb onco-surgeries, wherever possible along with nonopioids analgesics, are suggested. Short-acting opioids in small aliquots may be allowed to control breakthrough pain for expedient control of pain. The purpose of this consensus practice guideline is to provide the practicing anesthesiologists with best practice evidence and consensus recommendations by the expert committee of the Society of Onco-Anesthesia and Perioperative Care for safe opioid use in onco-surgeries.

Development and Validation of Pediatric Opioid Analgesia Self-Instruction System (PedOASIS): An Opioid Knowledge Tool for Pediatric Clinicians.

Acute pain is common in children and young adults with cancer and sickle cell disease. Current training curricula fail to adequately impart skills for pain management. We sought to develop and validate an education and assessment tool to address the safe effective use of opioids for pain management by pediatrics trainees. The first version of the tool contained 10 case-based, multiple-choice questions. It was pilot tested within a medium-sized pediatric residency program using preintervention and postintervention surveys to assess residents' knowledge and comfort related to prescribing opioids. Content validation was performed through an expert panel of physicians. Internal reliability was tested by administering the tool to learners and practitioners with varying levels of training. Comfort with choosing and converting between opioids increased significantly in pilot testing (P=0.005). Mean objective knowledge scores increased from 51% to 85.9% (P<0.001). The revised tool showed internal reliability within each group (Cronbach alpha 0.71 to 0.78) and significant differences in mean scores between groups (F ratio=9.45, P=0.0002). This tool demonstrates validity and internal reliability. Its use was associated with short-term educational gains and it garnered overall favorable feedback from users. Further testing is needed to assess the duration of these gains.

Perianesthesia Nurses’ Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids

<h3>Introduction</h3> Opioid overdose deaths and opioid use disorders are a crisis in the United States. Perianesthesia nurses have an excellent opportunity to educate patients and families who are discharged to home after surgery. <h3>Identification of the problem</h3> In a prior study, the authors found that nurses and other providers do not routinely discuss safe use, storage, or disposal of medications; perianesthesia nurses are more likely to discuss side effects of opioids. <h3>Purpose of the Study</h3> The purpose of this study is to determine if a web-based educational intervention increases knowledge, attitude, and intention of perianesthesia nurses to promote safe use, storage and disposal of opioids. <h3>Methodology</h3> A one group pre-test, post-test interventional study was conducted using a survey of ASPAN nurses. The intervention was a web-based voiceover module with patient education scenarios focused on information for patients before discharge. Responses to the pre-survey and 2 post surveys were collected. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. <h3>Results</h3> The participants included pre-test survey (n = 678), the immediate post-test (n = 247), and the 4-week post-test (n = 171). The analysis presented is limited to 247 who completed at least the first post-survey. For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in each model. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for perceived behavioral control, attitude, and intention, the difference between baseline and week 4 was not significant. <h3>Discussion</h3> These findings suggest a more intensive intervention with possibly the inclusion of booster sessions, particularly for the outcomes of perceived behavioral control and subjective norms may be needed. <h3>Conclusion</h3> This educational intervention can be implemented at the national level for optimum impact. <h3>Implications for perianesthesia nurses and future research</h3> Perianesthesia nurses are well-positioned to teach patients about the risks of diversion, nonmedical use, and proper disposal of opioids. Research to develop safe postdischarge prescription practices and encourage safe opioid practices after surgery is needed.

Leveraging Community Partnerships and Education to Improve the Safe Use, Storage and Disposal of Opioids

<h3>Introduction</h3> Literature suggests patients often have leftover opioids after surgery. It has also been reported that opioids are frequently not stored in a safe place at home. With the assistance of a community program, this hospital system received a donation of items to safely store and/or dispose of opioids to give to patients being discharged with an opioid prescription. <h3>Identification of the problem</h3> Utilizing the Instrument developed by Odem-Forren (Odom-Forren, Brady, Rayens, & Sloan, 2019), nurses were assessed for their knowledge and practice on safe opioids use, storage and disposal education. Gaps were identified across a community based hospital system with four hospitals and two outpatient surgery centers. <h3>EBP Question/Purpose: PICO question. Databases utilized</h3> For Perianesthesia nurses, will education and the availability of disposal and storage of opioid options for patients over standard of care, improve discharge teaching practice of safe use, storage and disposal of opioids and patient satisfaction scores? <h3>Methods/Evidence</h3> Education is key to increasing the patient's likelihood of disposal of opioids. To ensure proper education is being provided, nurses need to be knowledgeable about misuse of opioids in the community and the importance of storing or disposing of opioids safely. Champions were identified at each hospital in the system to ensure adoption. Disposal and storage items were compiled and "DASH" (Disposal And Storage at Home) bins were created for each unit that discharges outpatient surgery patients. The education plan was developed based on gaps in knowledge and practice from survey. Education is currently in progress with post-survey to follow. <h3>Significance of Findings/Outcomes</h3> Monitoring for improved patient satisfaction scores, increase in documentation of education, disposal and storage items given and improved post implementation survey results will occur. Results will be analyzed in December 2020. <h3>Implications for perianesthesia nurses and future research</h3> Perianesthesia nurses play a critical role educating patients. Because of this, it is crucial we as nurses are knowledgeable and aware of the safe use, storage and disposal practices that are recommended. Being able to supply patients with the needed items to safely store and dispose of opioids is an added benefit that should be considered whenever possible.

"I Prefer to Stay Away": A Qualitative Study of Patients in an Opioid-Sparing Pain Management Protocol.

The aim of this study was to explore beliefs and behaviors of opioid pain medications among patients undergoing elective surgery. Opioid dependence after surgery is a major contributor to the ongoing opioid epidemic. Recent efforts by surgeons and health systems have sought to improve the education patients receive regarding safe opioid use after surgery; however, little is known about patients' pre-existing beliefs surrounding opioids. Semistructured interviews were conducted with patients who underwent 1 of 4 common elective surgical procedures at 1 institution. Patients were specifically asked about their knowledge and beliefs about opioids before surgery and their opinions of opioid-sparing recovery after surgery. Coding was conducted through iterative steps, beginning with an initial cycle of rapid analysis, followed by focused coding, and thematic analysis. Twenty-one patients were interviewed. Three major themes emerged regarding patient opinions about using opioids after surgery. First, there was widespread awareness among patients about opioid medications, and preoperatively, patients had specific intentions about using opioids, often informed by this awareness. Second, patients described a spectrum of opioid related behavior which both aligned and conflicted with preoperative intentions. Third, there was tension among patients about opioid-free postoperative recovery, with patients expressing support, opposition, and emphasis on tailoring recovery to patient needs. Patients undergoing common surgical procedures often arrive at their surgical encounter with strong, pre-formed opinions about opioids. Eliciting these preexisting opinions may help surgeons better counsel patients about safe opioid use after surgery.

Risk factors of chronic opioid use after surgical procedures in noncancer patients: A nationwide case-control study.

Surgery is an indication for opioid prescription in noncancer patients, and chronic use of opioids is associated with overdose and abuse. We aimed to evaluate the prevalence and risk factors associated with chronic opioid use (COU) following surgery among noncancer patients. A nationwide case-control study. Retrospective analysis of the annual national patient sample data from 2012 to 2018 in South Korea. Adults without cancer who had undergone surgery and received noninjectable opioids during hospital stay. COU during 3 months following surgery. A total of 15 543 participants were included, and the prevalence overall and in opioid-naïve users was 8.1 and 5.7%, respectively. Prior exposure patterns of opioids [intermittent user, adjusted odds ratio (aOR) 2.35; 95% CI, 2.00 to 2.77, and continuous user, aOR 8.58; 95% CI, 6.54 to 11.24] and concomitant use of benzodiazepine (in continuous user, aOR 18.60; 95% CI 11.70 to 29.55) were strongly associated with COU compared with naïve users. Morphine milligram equivalent, type of opioid strength at discharge and prescription of nonopioid analgesics at discharge were also associated with COU. Compared with minor surgery, knee (aOR 1.49; 95% CI 1.17 to 1.89), spine (aOR 1.65; 95% CI 1.33 to 2.06) and shoulder (aOR 2.54; 95% CI 1.97 to 3.27) procedures showed a significantly positive association with COU. Sensitivity analysis in opioid-naïve patients showed similar results. About 8.1% of noncancer patients who had undergone surgery and were prescribed noninjectable opioids became chronic opioid users in Korea. Identified risk factors could be used to derive strategies for safe opioid use in noncancer patients in the future.

O84: OPIOID PRESCRIPTION AT OPERATIVE DISCHARGE (OPIOID STUDY)

Abstract Presenting Author Email: etheophilidou@gmail.com Research Question Opioid misuse is a major health epidemic. Surveys in the US have shown that over 130 patients die daily due to opioid related drug overdose with 10.3 million patients misused prescription opioids in 2018. This is the first study in the UK to explore the magnitude of the opioid crisis in our country. The opioid crisis was identified first in the US after life expectancy reduced dramatically in 2015. One of the main reasons attributed to this was the increase in the number of overdoses and suicides, both linked with the use of opioid drugs. Between 1999 and 2017 the number of deaths from opioid overdoses increased almost six fold. The 2019 National Survey on Drug use and Health in the US showed that 10.3 million patients misused prescription opioids in 2018 and 2 million patients with an opioid use disorder. Factors contributing to opioid dependence were identified as the use of modified release formulations, the use of repeat opioid prescriptions and the treatment of acute pain. Background and Aim The aim of the study is to explore the magnitude of the opioid crisis in the UK, by identifying risk factors for persistent opioid use following major general surgical intervention. Design Phase 1 of the OPiOiD study is a national retrospective audit. We are aiming to identify risk factors for persistent opioid use in patients undergoing major general surgical interventions. Specifically we will be assessing the number of patients given a duration or point of review when opioids should be stopped and whether any written information has been given to these patients on discharge regarding safe use of opioids and de-prescribing advice. 23 hospitals across the UK have registered so far. Data are collected using the electronic discharge summaries send to the GPs and copies given to patients. Phase 2 of the study will be to proceed with a national observational study with the aim to develop strategies to promote safe and effective management of acute pain. Team and infrastructure The East Midlands Surgical Academic Network (EMSAN) leads the study, supervised by Dr Roger Knaggs, Associate Professor School of Pharmacy University of Nottingham, Dr Nicholas Levy, Department of Anaesthesia and peri-operative Medicine West Suffolk NHS Foundation Trust and Professor Dileep Lobo, Nottingham Digestive Diseases Centre National Institute for Health Research.

Can educational videos reduce opioid consumption in trauma inpatients? A cluster-randomized pilot study.

Opioids are often used to treat pain after traumatic injury, but patient education on safe use of opioids is not standard. To address this gap, we created a video-based opioid education program for patients. We hypothesized that video viewing would lead to a decrease in overall opioid use and morphine equivalent doses (MEDs) on their penultimate hospital day. Our secondary aim was to study barriers to video implementation. We performed a prospective pragmatic cluster-randomized pilot study of video education for trauma floor patients. One of two equivalent trauma floors was selected as the intervention group; patients were equally likely to be admitted to either floor. Nursing staff were to show videos to English-speaking or Spanish-literate patients within 1 day of floor arrival, excluding patients with Glasgow Coma Scale score less than 15. Opioid use and MEDs taken on the day before discharge were compared. Intention to treat (ITT) (intervention vs. control) and per-protocol groups (video viewers vs. nonviewers) were compared (α = 0.05). Protocol compliance was also assessed. In intention to treat analysis, there was no difference in percent of patients using opioids or MEDs on the day before discharge. In per-protocol analysis, there was no different in percent of patients using opioids on the day before discharge. However, video viewers still on opioids took significantly fewer MEDs than patients who did not see the video (26 vs. 38, p < 0.05). Protocol compliance was poor; only 46% of the intervention group saw the videos. Video-based education did not reduce inpatient opioid consumption, although there may be benefits in specific subgroups. Implementation was hindered by staffing and workflow limitations, and staff bias may have limited the effect of randomization. We must continue to establish effective methods to educate patients about safe pain management and translate these into standard practices. Therapeutic, Level IV.

Opioid prescribing: helping patients break free from risk

Prescribed opioids are in common use yet can have grave side effects, as seen in the dependency epidemic in the US. Read how to spot red flags, advise on safe opioid use and support holistic management of chronic pain

The Oxford Catalogue of Opioids: A systematic synthesis of opioid drug names and their pharmacology.

AimThe growing demand for analgesia, coupled with an increasing need to treat opioid dependence and overdose, has escalated the development of novel opioids. We aimed to quantify the number of opioid drugs developed and to catalogue them based on their pharmacology.MethodsWe conducted a systematic search of seven sources in November 2020, including the WHO's Anatomical Therapeutic Classification index, the British National Formulary, the IUPHAR/BPS Guide to Pharmacology, the International Narcotics Control Board Index of Names of Narcotic Drugs, the WHO's International Nonproprietary Names MedNet service, Martindale's Extra Pharmacopoeia and the Merck Index, to include opioid drugs that targeted or had an effect or coeffect at one or more opioid receptors. We extracted chemical and nonproprietary names, drug stems, molecular formulas, molecular weights, receptor targets, actions at opioid receptors and classes based on their origins. We used descriptive statistics and calculated medians and interquartile ranges where appropriate.ResultsWe identified 233 opioid drugs and created an online resource (https://www.catalogueofopioids.net/). There were 10 unique drug stems, and “‐fentanil” accounted for one‐fifth (20%) of all opioids. Most of the drugs (n = 133) targeted mu‐opioid receptors and the majority (n = 191) were agonists at one or more receptors. Most (82%) were synthetic opioids, followed by semisynthetic opioids (16%) and alkaloids (3%).ConclusionThis catalogue centralizes and disseminates information that could assist researchers, prescribers and the public to improve the safe use of opioids.

Educating surgical patients about safe use of opioids: a randomized controlled trial

BackgroundCurrently, it is not routine practice in the preoperative clinic to provide standardized patient education for safe postoperative opioid use. We aimed to evaluate the impact of an educational pamphlet for surgical patients on knowledge about safe opioid use. MethodsThis multi-center randomized controlled study recruited 100 adult patients in the preoperative clinic. All patients completed a baseline knowledge questionnaire consisting of 10 questions. Patients were randomized to intervention: educational pamphlet, or control: no pamphlet. Questionnaires were repeated immediately post-education in the intervention group, and at 15, and 30 days after surgery in both groups. The primary outcome was change in knowledge score post-education in the intervention compared to control group. ResultsBetween groups, the immediate post-education score in the intervention group was significantly higher than control group baseline 34.2 [95% Confidence interval (CI) 33.1-35.3] vs 28.3 [95% CI 26.6-29.9]; P<0.0001). In intervention vs control group, mean scores were significantly higher 31.6 (95% CI 30.5-32.7) vs 29.1 (95% CI 27.9-30.2; P=.002) at 15 days, and 32.4 (95%CI 31.4-33.5) vs 30.5 (95% CI 29.2-31.7; P=.017) at 30 days postoperatively. ConclusionsEducating surgical patients with a simple educational pamphlet improved patients’ scores on a standardized test about opioids up to 30 days after surgery.

Academic detailing with ambulatory pharmacists to support naloxone counseling

BackgroundPharmacists are critical to public health in supporting safe use of prescription opioids by ensuring that all patients are offered and counseled on naloxone. Academic detailing may be an effective educational outreach strategy for improving pharmacists’ knowledge and behavior related to naloxone. ObjectiveTo describe an academic detailing program to pharmacists on the topic of counseling and promoting naloxone to patients. MethodsPharmacists were recruited by convenience sampling. Three pharmacists who were experienced with academic detailing techniques provided the education. Survey data were collected to evaluate the program. ResultsThirty-three pharmacists participated, including 16 sessions that were delivered virtually. The pharmacists worked in a variety of ambulatory settings, including chain or corporate-owned pharmacies (58%), hospital-owned specialty pharmacies (15%), hospital-owned community pharmacies (15%), and independently owned or other pharmacies (12%). Twenty-eight pharmacists (85%) completed an immediate post-session evaluation survey. Twenty-seven pharmacists (96%) indicated they felt the information presented will impact their practice or patient care. Eleven pharmacists (33%) completed a second post-session survey, self-reporting improvements related to counseling patients about naloxone. Conclusion: Participating in academic detailing supports community pharmacists’ providing patient counseling about naloxone. Further study, particularly related to virtual academic detailing, is necessary to understand the full potential of academic detailing to pharmacists.

The Effect of Preoperative Opioid Education on Opioid Consumption After Outpatient Orthopedic Surgery: A Prospective Randomized Trial.

Pain management and opioid consumption following outpatient orthopedic surgery may be influenced by several variables, including knowledge of safe opioid use. A prospective randomized study was undertaken to understand the effect of preoperative opioid education on opioid consumption following outpatient orthopedic surgeries. A total of 237 patients undergoing outpatient orthopedic surgeries were prospectively randomized to receive preoperative opioid education or not. Postoperative data collected included the number of pills taken, daily visual analog scale (VAS) pain scores, adverse events, and attitude toward the pain experience. A total of 107 patients were randomized to receive preoperative education and 130 to not receive preoperative education. On average, 27 pills were prescribed to each patient. The preoperative opioid education group consumed significantly fewer opioids (6 pills) when compared with the group not receiving education (12 pills) (P<.05). The findings were the same with upper and lower extremity surgeries. Overall, the 2 groups of patients had similar daily VAS scores and were satisfied with their postoperative pain experience irrespective of opioid education. Of the total opioid pills prescribed during the study, only 46% were ultimately consumed. Preoperative education significantly reduced the number of prescription opioid pills and total morphine equivalents consumed by patients in the period following outpatient orthopedic surgery, with no negative effects on pain experience. This finding was consistent in both upper and lower extremity surgery. Approximately twice the number of opioids were prescribed than ultimately consumed by patients. [Orthopedics. 2021;44(2):123-127.].

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

Perianesthesia Patient Education for the Promotion of Opioid Stewardship

Opioid overdose deaths and opioid use disorders are a crisis in the United States and other western countries around the globe. Opioid prescriptions more than doubled after the turn of the century, particularly for postoperative patients. Unfortunately, many who have abused opioids were able to obtain those opioids from friends or family who had held on to prescribed, but unused opioids. One method to manage and decrease the opportunity for unused opioids to become black-market opioids is to educate patients and families regarding the safe use, safe storage, and proper disposal of unused prescription opioids. Perianesthesia nurses, particularly those who educate patients before and after surgery, have an excellent opportunity to educate patients and families who are discharged to home after surgery.

Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California.

The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.

Economic burden of opioid crisis and the role of pharmacist-led interventions

Opioids are often used to treat pain and improve function. Canada and the United States are one of the highest users of opioids per capita worldwide and are experiencing the devastating consequences of the opioid crisis. The objectives of this commentary are 2-fold: first, highlight the economic burden of the opioid crisis in the United States and Canada; second, define the role of pharmacists to address this crisis. A body of literature delineates the cost of this crisis to health care system, lost productivity, and law enforcement. Contemporary data indicate that the economic burden of the opioid crisis was $78.5 billion and $3.5 billion in the United States and Canada, respectively. Community pharmacists are often the first health care providers who identify issues with opioid prescriptions, signs of misuse, abuse, and diversion. Contemporary studies highlight their critical role to address this crisis by ensuring the safe and appropriate use of opioids, which can decrease morbidity, mortality, use of health services and societal resources, and costs. The expanding scope of practice and the amendment of existing regulations and legislations have the potential to maximize the contribution of pharmacists to address this crisis. Pharmacists should be reimbursed for the services they provide to be sustainable.