Opioid Tapering: Pharmacists Can Make a Difference

In 2020, approximately 92,000 drug overdose deaths occurred in the United States. A whopping 75% of those deaths involved opioid use.

Opioid misuse in the United States is the main driver of overdose deaths, yet dispensing rates remain high. Opioid tapering to safer levels has shown to be effective in preventing misuse in patients.

Kaiser Permanente Northwest implemented an opioid tapering program led by pharmacists called the Support Team Onsite Resource for Management of Pain (STORM). Qualitative interviews performed by research staff evaluated patient experiences with STORM, highlighting strengths and weaknesses.

Each patient in the program had an interprofessional team made up of pain management pharmacists, a physician, a social worker, and a registered nurse who worked to deliver the program. The results of this study proved that pharmacists, being one of the most accessible health care professionals, are critical pieces of the opioid tapering program puzzle.

All patients eligible for STORM needed a referral from their primary care provider. There were no requirements for duration of use or dose for a referral.

Pharmacists developed individualized tapering plans with each patient. Pharmacists also gave patients non-pharmacologic pain management recommendations and continued support through telephone calls.

Of the 25 patients who participated in the interview process, 80% were female with a mean age of 58 years. The most common conditions present in participants were back pain, knee pain, arthritic conditions, and fibromyalgia.

A key finding from the interviews was that more than half of the patients said they did not like using opioids for their pain. Although 64% of patients reported that they still used opioid medication after the tapering program, a significant amount reported using lower doses than before the intervention.

The patients’ milligram morphine equivalents (MME) mean considerably decreased from 108 to 45 after the program. The STORM program resulted in 72% of participants reporting their pain being manageable or reduced after completing the taper.

Patients who were satisfied with the STORM program experienced:

• Pharmacist skill set and support
• Accessibility
• Knowledge, advocacy, and oversight
• Flexible pace
• Emotional and physical improvements

Patients who were dissatisfied with the STORM program experienced:

• Unhelpful recommendations for non-pharmacological pain management
• Quality of life impacts
• Lack of choice in taper elements
• Minimal contact with a pharmacist

Overall, 72% of patients indicated that they would complete the STORM program again. Four patients expressed their lack of need for the program due to their boost of confidence in properly tapering on their own. However, additional studies are necessary to establish the true efficacy of opioid tapering programs.

“Patient-centered, individualized care, which is consistently identified as a facilitator of successful tapering was foundational to the STORM program design,” they wrote.

Patients appreciated pharmacists’ knowledge base and accessibility throughout the program. Having someone easily available to support and answer concerns was pivotal for the majority of patients.

The data from this study suggest that having empathetic, caring, and accessible pharmacists leading opioid tapering programs enhances patient experience and adherence.

About the Author

Karisse Lora is a 2023 PharmD candidate at the University of Connecticut.

REFERENCES

Schneider, Jennifer L et al. “"I really had somebody in my corner." Patient experiences with a pharmacist-led opioid tapering program.” Journal of the American Pharmacists Association : JAPhA, S1544-3191(22)00157-1. 26 May. 2022, doi:10.1016/j.japh.2022.05.019

Death Rate Maps Graphs. Centers for Disease Control and Prevention. (2022, June 2) https://www.cdc.gov/drugoverdose/deaths/index.html