What is the Pharmacist's Role in Assessing CAM Use?

Today, most patients self medicate with both traditional medicine and complementary and alternative medicine (CAM). The United States, as a cultural melting pot, has a growing armamentarium of natural, herbal, vitamin, and traditional cures available in grocery stores, gas stations, drugstores, health food stores, and from the Internet. What do pharmacists need to know?

Pharmacists from the University of Macau in Macau, China have assembled a meta-analysis of studies that look at the community pharmacist responsibilities in terms of traditional and complementary and alternative medicines. Published in Research in Social and Administrative Pharmacy, this study finds that 3 factors influence the pharmacists’ responsibilities: the breadth of medication use, pharmacists' objectives, and stakeholders' perspectives.

Barriers to understanding CAM use include a lack of information about their use in organ impairment, poor data about the true incidence of adverse drug reactions associated with CAM, and the wide variety of locations where patients can purchase CAM.

Evidence indicates that the pharmacist's role should expand to include CAM. Literature published in the last 15 years to determine exactly where pharmacists need to intervene is extensive. Here's what researchers have concluded:

• Pharmacists have a professional responsibility to acknowledge and seek out information about patients' CAM use.
• Pharmacists need to increase their knowledge base about CAM so they have a basic understanding of what various products do and what their risks are.
• Pharmacists can and must help patients use CAM appropriately and safely.
• Pharmacists should have knowledge of when patients who use CAM experience adverse drug events, and report them appropriately.
• Pharmacists need to educate patients about CAM and its potential benefits and risks.
• Pharmacists approach to CAM needs to be collaborative in nature, and they need to work with health care professionals so that they are aware that the patient is taking CAM and it's documented in the medical record.

These findings indicate that pharmacists’ professional responsibilities for CAM are not terribly different than those for traditional medicines. Pharmacists who accept these responsibilities will need to look for resources that can help them augment their traditional training with information focused directly on CAM.

Pharmacists can start by understanding the scope of the problem and defining CAM. It's especially important to know what patients tend to use in specific geographic areas. In addition, pharmacists need to ask patients about CAM use. If patients are using CAM, it's critical for pharmacists to ask them why, how it's working, and if they're having any difficulties.

Pharmacists also need to acknowledge the many stakeholders in the CAM discussion. Pharmacists and patients are obviously involved, but policymakers, regulators, professional organizations, academia, traditional physicians, alternative practitioners, and the pharmaceutical/CAM industry are all involved as well. We must work together to ensure the CAM is used responsibly and appropriately.

Reference

Ung COL, Harnett J, Hu H. Community pharmacist's responsibilities with regards to traditional medicine/complementary medicine products: A systematic literature review. Res Social Adm Pharm. 2017 Jul - Aug;13(4):686-716.