Opioid Stewardship Pharmacist: Innovative Approaches to Pain Management

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

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 second interview in the series, and it is with Jeff Boyer, PharmD, BCPS, a pharmacist at Southern Arizona VA Healthcare System.

Boyer discusses his role and recent initiatives in opioid stewardship. As a facility program coordinator, Boyer oversees aspects of pain management, opioid safety, and prescription drug monitoring. His responsibilities include budget reporting, developing pain clinic capabilities for patients with chronic pain, and maintaining interdisciplinary communication within the Stepped Care Model of Pain. He also mentors new pain management pharmacists, educates providers on best practices, and monitors opioid utilization trends to guide facility policies.

Boyer’s recent projects include developing a perioperative IV methadone protocol, collaborating on overdose education with pharmacy and mental health services, and implementing functional-based assessments to evaluate opioid therapy outcomes. Additionally, he participates in an interdisciplinary pain rehabilitation program to provide patient education on non-opioid analgesics, opioid risks, and overdose prevention.

Tracking and assessing trends in opioid use data while balancing prescribing guidelines with patient safety are critical to guiding effective pain management and addressing the ongoing opioid epidemic. Image Credit: © Antonio Rodriguez - stock.adobe.com

For successful opioid stewardship, Boyer emphasizes the importance of visibility and accessibility as a subject matter expert, providing education, informal consultations, and non-opioid options for pain management. Familiarity with facility policies, state statutes, and guidelines are key, as well as expertise in interpreting urine drug tests to support patient-provider relationships. Tracking and assessing trends in opioid use data while balancing prescribing guidelines with patient safety are critical to guiding effective pain management and addressing the ongoing opioid epidemic.

Pharmacy Times: What is your practice setting and role?

Jeff Boyer, PharmD, BCPS: I work as a facility program coordinator all for all aspects of pain care, including pain management, opioid safety, and the prescription drug monitoring program. I have a unique role as a program coordinator in that I assist in the budget reporting, building our pain clinic to better meet the complex needs of chronic pain patients, and maintaining bidirectional communication and continuity between service lines and specialties within the Stepped Care Model of Pain. Part of my time is also devoted to clinical treatment of chronic pain and substance use disorders. Mentoring and coaching newer pain management pharmacists and detailing providers on pain management best practices, risk mitigation, and treatment for opioid use disorder is another aspect that is very rewarding and necessary when it comes to understanding the options available for pain and when opioid therapy may or may not be an appropriate part of the treatment plan.

As an opioid steward, I collect quarterly data on opioid utilization trends and present to our pain committee and medical executive board. Identification of negative trends are addressed with action plans through our pain committee and facility subject matter experts.

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

Boyer: Most recently I’ve been collaborating with anesthesiology for review of a perioperative intravenous methadone protocol for submission to the pharmacy and therapeutics committee, as well as partnering with pharmacy and mental health service lines to utilize text response outreach for overdose education and naloxone distribution. I have also presented to our facility pain committee on a national initiative to utilize multidomain assessment tools for better understanding of the patient’s pain experience. Utilizing functional based assessments and reiterating the purpose of functional assessments rather than unidimensional pain scores can assist in determination of opioid therapy success or failure.

I have also become a member of an interdisciplinary pain rehabilitation program recently launched at our facility. My piece is educating patients about pharmacotherapy, including the multiple non-opioid analgesic options available, while providing opioid and overdose education as well as addressing the potential risks associated with cannabis use.

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

Boyer: Putting yourself out there and making yourself visible as a subject matter expert and sounding board goes a long way. Willingness to step up and provide educational opportunities, informal consults when appropriate, and familiarize clinicians with the non-opioid and non-pharmacological approaches to pain management offered at your institution is also valuable as these may not always be common knowledge or well-understood. Additionally, becoming well-versed in facility policies and how they compare to state statutes and current guidelines helps clarify situations in which providers may not feel comfortable or want to be thorough in documentation and patient safety.

Becoming an expert on urine drug testing results comes in quite handy as well. Failure to assess urine drug testing results accurately can quickly result in dissolving a patient-provider relationship or potentially missing an opportunity to address a substance use disorder.

Lastly, the ability to objectively track and assess trends in opioid utilization data while understanding the limitations and unique patient experiences embedded in this information is crucial. This is particularly important when balancing changes in opioid prescribing guidelines while continuing to recognize the severity of the opioid epidemic. It is imperative to understand when opioid therapy is not an appropriate plan of care and when to advocate for the judicious use of this class of medication.

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