1 / 9

Bay Area Prescription Drug Abuse Summit: Pharmacist Perspective

Bay Area Prescription Drug Abuse Summit: Pharmacist Perspective. Lori Reisner, Pharm.D. Health Sciences Professor of Clinical Pharmacy University of California Medical Center, San Francisco May 7, 2014. Background. Opioid use in primary care:

calvin
Télécharger la présentation

Bay Area Prescription Drug Abuse Summit: Pharmacist Perspective

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bay Area Prescription Drug Abuse Summit:Pharmacist Perspective Lori Reisner, Pharm.D. Health Sciences Professor of Clinical Pharmacy University of California Medical Center, San Francisco May 7, 2014

  2. Background Opioid use in primary care: • 300% increase in opioid analgesic prescriptions between 1999 -2010 • Painkiller overdose deaths among women increased 5-fold and 3.6 times among men increased • Similar increases occurred in opioid-related ED visits and hospitalizations • Mean annual direct health care costs for patients who abuse opioids are 8.7-times higher than for non-abusers • Chronic pain may be present in up 20-50% of primary care physicians’ patients, and opioids are an essential component of their armamentarium • Regulatory responsibilities and scrutiny of opioid prescribing are increasing CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6

  3. Background • Prescription drug-related deaths now outnumber those from illicit substances • CDC reported 14,800 deaths from opiate overdose in 2008 • Sedative combinations contribute to a significant percentage of deaths • Benzodiazepines • Non-benzodiazepine sedatives (e.g., carisoprodol, zolpidem) • Alcohol and other sedatives CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6

  4. rate, Nebraska.4 Drug Overdose Rates by State, 20084 Overdose rates by state

  5. San Francisco 2009 and 2010 • 209 drug-related deaths, up from 41 the year prior • Oxycodone was detected in 53 of the total • 25 percent of accidental drug-related deaths in San Francisco involved oxycodone • Dr. Nikolas Lemos, chief forensic toxicologist at the Office of the San Francisco Medical Examiner, quoted by SF Weekly • Contrast with 29 deaths due to motor vehicle accidents during that period

  6. Influences on Morbidity/Mortality • Underlying comorbidities • Sleep apnea/respiratory disease • Cardiovascular diseases • Obesity/metabolic diseases • Reimbursement systems • Less face-to-face patient time • More reliance on medications/prescribing options • Limited options (insurance restrictions) • HCAHPS Scores • Reimbursement determined by percentiles • Reliance on pain scores may pressure prescribers to use more opioids • Prescriber Education • Lack of knowledge about non-opioid options • Inadequate trial periods/Inadequate dosing • Drug-drug interactions • Pharmacokinetics: Frequency of long-acting meds/Dose adjustments • Regulatory • Intensifying scrutiny of less offensive agents, e.g., tramadol

  7. Challenges • Retail Pharmacist have little experience with appropriate pain regimens • May lack information regarding combination therapies (multiple prescribers/pharmacies) • Fear of challenging physician prescribing • Cannot reliably confirm misuse/abuse or counterfeits • Integrating non-pharmacological interventions and modalities • Prescribers subscribing to “harm reduction” philosophies • Developing safer medications: abuse-limiting modifications

  8. Example Multimodal Regimen UCSF Arthroplasty (Joint replacement) Service: • Acetaminophen 1000 mg PO Q6H • Celecoxib 200 mg PO BID* • Gabapentin 300 mg PO TID* • Oxycodone 10 mg PO Q4H PRN moderate pain • Morphine 2 mg IV Q2H PRN severe pain • Epidural catheter w/ ropivacaine & fentanyl • +/- peripheral nerve infusion (local anesthetic) *may be omitted or dose-adjusted depending on comorbidities or meds prior to admission

  9. Recommendations • Improved Prescriber Education • Limited utility and persistence • Mandated curriculum? • Mandated re-certification? • Prescription pattern audits (Controlled Substance Utilization Review and Evaluation System, CURES) • Development of Pain Management Specialist/Consultant Certification across Professional Domains • Will require accepted certification/accreditation standards • Pharmacist Empowerment • Retail, hospital and ambulatory practices • Patient Education • Balancing portrayal in popular media, e.g., television • Instruction in proper use and risks • Reimbursement: adequate for appropriate patient care

More Related