Opioid Stewardship Pharmacist: Advancing Pain Management and Safe Opioid Use in Cancer Care

Since the declaration of the opioid epidemic as a public health emergency in 2017, many hospitals and health systems have put infrastructure in place to ensure safe and appropriate use of opioids.¹ As medication experts, pharmacists often play a key role in opioid stewardship, leading taskforces and quality initiatives in addition to participating in direct patient care. Opioid prescription volumes have dropped significantly over the past several years while opioid overdoses have remained persistently high, necessitating a shifting focus of opioid stewardship.²

As medication experts, pharmacists often play a key role in opioid stewardship, leading taskforces and quality initiatives in addition to participating in direct patient care. Image Credit: © BillionPhotos.com - stock.adobe.com

Pharmacy Times reached out to several pharmacists serving in opioid stewardship roles across the country to discuss what is currently a priority for their organizations and what they see as keys to success in stewardship. This is the third interview in the series, and it is with Maureen Saphire, PharmD, BCGP, an opioid stewardship pharmacist at the James Comprehensive Cancer Center at the Ohio State University Medical Center.

Maureen Saphire, PharmD, BCGP, an opioid stewardship pharmacist at The James Comprehensive Cancer Center at Ohio State University Medical Center, discusses her dual role in palliative care and opioid stewardship for cancer patients. She works with a team of palliative care pharmacists, focusing on managing pain and symptoms for patients with advanced illnesses, including those with cancer and substance use disorders.

Saphire describes her recent efforts in opioid stewardship, particularly advocating for better formulary access to opioids for patients with cancer and sickle cell disease and promoting buprenorphine as a safer opioid option for chronic pain. Her team is also developing clinical guidelines to ensure safe and appropriate opioid prescribing within regulatory frameworks.

Pharmacy Times: What is your practice setting and role?

Maureen Saphire, PharmD, BCGP: I am a specialty practice pharmacist in palliative medicine and opioid stewardship within The James Comprehensive Cancer Center at The Ohio State University Medical Center. In my clinical role, I work with our outpatient palliative interdisciplinary team caring for patients with cancer who need specialty care for uncontrolled symptoms and an added layer of support throughout their cancer journeys. We have a strong team of 6 palliative medicine pharmacists at our institution who use clinical privileges to assist our inpatient and outpatient palliative medicine teams with assessing and managing a variety of symptoms associated with advanced illness, including co-existing pain and substance use disorders. Two years ago, with support from the department of pharmacy and a physician champion, I began dedicating half of my time to developing an opioid stewardship program within the cancer center. In this role, we focus on increasing access to opioids for patients with cancer and sickle cell disease, and promoting safe and effective use of opioids and other analgesics.

Pharmacy Times: What projects have you been involved in recently?

Saphire: Patients who often require opioids for their pain conditions, such as patients with cancer or sickle cell disease, have experienced unintended harms from our local and national efforts to decrease nonmedical opioid use. Some of my work lately has focused on advocating for payors to loosen their formulary restrictions on opioid use for beneficiaries receiving opioids for cancer-related pain and promoting increased access to buprenorphine as a safer and more tolerable opioid for managing chronic pain conditions.

Additionally, we are working on a clinical practice guideline for our health system which aims to promote safe and appropriate opioid prescribing within national guidelines and state regulatory frameworks and empower ambulatory prescribers to manage pain with opioids when it is appropriate to do so.

Pharmacy Times: What do you see as key to success in building and maintaining an opioid stewardship program?

Saphire: Having leadership support is one of the biggest keys to success in moving opioid stewardship initiatives forward. When tackling larger projects, proper planning up front, such as identifying and including the right stakeholders, will save time in the long run. At a large institution, it's easy to become frustrated when work moves slowly or when you hit roadblocks, so I've learned to keep myself motivated by celebrating small wins along the way.

REFERENCES

1. Uritsky TJ, Busch ME, Chae SG, Genord C. Opioid Stewardship: Building on Antibiotic Stewardship Principles. Journal of Pain & Palliative Care Pharmacotherapy. 2020;34(4):181-183. doi:10.1080/15360288.2020.1765066

2. Overdose epidemic report 2023. American Medical Association. 2023. Accessed October 30, 2024. https://www.ama-assn.org/system/files/ama-overdose-epidemic-report.pdf