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Canadian Pharmacists Association launches Pharmacists’ Opioid Stewardship Initiative as first focus area for CPHS 2020.
The Canadian Pharmacists’ Harmonization Scope (CPHS) 2020, the CPhA initiative that aspires to define, describe and develop a national, forward-looking harmonized scope of practice for pharmacists, is focusing its efforts on a specific, and very timely, therapeutic area with the launch of the Pharmacists’ Opioid Stewardship Initiative (POSI).
The opioid epidemic is one of the most challenging and complex health crises in Canada today. More than 14,000 Canadians have been killed by opioids over the last 4 years, and close to 20,000 people have been hospitalized for opioid-related poisoning.
“Pharmacists are the most accessible healthcare providers and could fill a critical system gap. They are often the first health care provider to observe signs of opioid use disorder,” said Shelita Dattani, director of practice development and knowledge translation at CPhA, in a news release. “Many are already helping by optimizing patients’ opioid therapy through pain assessment, medication reviews, monitoring for interactions, medication administration, exemptions for prescribing suboxone and methadone, ensuring appropriate dosing and consulting on switching or tapering of opioids.”
CPhA has been a strong advocate for more opportunities and supports for pharmacists in the management of opioid therapy. This includes listing pharmacists as practitioners within the Controlled Drugs and Substances Act (CDSA), which would expand pharmacists’ scope for prescribing and adapting opioids for their patients.
“Because of the COVID-19 pandemic, temporary exemptions have been made under the CDSA, creating an opportunity to provide continuity of care to some of the most vulnerable Canadians and helping us ensure that their care is not interrupted, especially in times where they may be experiencing more stress, anxiety and isolation,” added Dattani.
These exemptions permit pharmacists to care for their patients by extending prescriptions, transferring prescriptions to other pharmacists, receiving verbal orders and allowing other pharmacy employees to deliver prescriptions of controlled substances to patients’ homes or other locations where they may be. In some provinces, pharmacists are also now permitted to adapt (i.e., modify the dosage, formulation or regimen) prescription-controlled drugs and substances to help in the care of their patients.
“To achieve success for this initiative we have a plan focusing on solid communication and strong engagement from our pharmacy community and beyond so that we can all be ambassadors for full harmonized scope of practice to improve the health of Canadians,” said Dattani.
This work involves engaging the pharmacy community, other healthcare providers, patients, the public and governments about how the work of the POSI can meet their needs. The initiative will support and enable national and provincial efforts to extend, expand and harmonize scope of practice across the country with respect to the exemptions under the CDSA, including the ability to adapt prescriptions. The work of CPHS POSI will also identify other areas where pharmacists can make an impact in patient care.
“Our goal is to use the Pharmacists’ Opioid Stewardship Initiative as a model for future phases of CPHS 2020 work — taking a patient and health system needs approach to identify subsequent areas of focus,” said Dattani.
By Richard Kelch
Earlier this winter I was asked to give a presentation to a group of peers that centred on breaking down barriers surrounding naloxone.
It was to be my first time presenting to a group of professional peers so I was quite nervous, to be honest, and, not wanting to look foolish, I set about making sure that I had as many facts and figures as I could find. Full disclosure here, I had dispensed my fair share of Naloxone to my clients, but I’d always had this nagging doubt when I would start a conversation with someone about this potentially life-saving tool.
Armed with the fear of looking foolish I set out to figure out just why, when there is an opioid overdose death every 10 hours in Ontario alone and there is an opioid prescription filled almost every second of an average working day, there are so few people having conversations with us about obtaining naloxone.
Along the way of researching for my session I rediscovered the fact that pharmacists are still viewed as one of the most trusted professionals in society; people want to listen to what we have to say! I also found that in focus groups of pharmacists, there is either a belief that the opioid issue doesn’t affect their communities or that there is a profound discomfort in initiating a talk with a patient about obtaining naloxone.
So, I challenged myself to pursue the conversations that need to happen. Armed with the knowledge that people trust us, I took a hard look at profiles of patients who are higher risk of overdose and I simply asked if I could talk to them about naloxone because I felt it is important for their safety. I was overwhelmed at how receptive people could be; they told me stories of family members and acquaintances who could have used this information. Some were skeptical of course, but never has anyone been offended or angry. If anything, I have been overwhelmed by the sense of relief from patients that someone is looking out for them.
It hit me that what I had thought of as being a difficult topic to broach was actually so simple once I stopped letting my own discomfort get in the way. Patients want to have these conversations with us, maybe it’s time that we overcome our own barriers to talking about difficult topics and treat them like the matter-of-fact issues that they are.
Richard Kelch is an award-winning community pharmacist who graduated from the University of Toronto in 1989 and founded Northgate Pharmacy in Sarnia in 2007. Since opening, the pharmacy has grown to encompass appointment-based dispensing, travel medicine and managed weight loss, among other traditional services.
