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What are the practical steps pharmacists can take to aid in safe and appropriate use of opioid analgesics?

As concerns grow over the inappropriate use of opioid analgesics, is there anything pharmacists can do to help prevent harm from occuring and improving quality use of these medicines?
 
Writing in the SHPA’s Journal of Pharmacy Practice and Research, Tony Hall, a senior lecturer and clinical Pharmacist at Queensland University of Technology said there are a range of measures that pharmacists can do to help.
 
According to Mr Hall, Pharmacists can contribute to the quality use of all opioid medication use in chronic non-cancer pain by:
  • avoiding describing analgesic medicines as pain killers
  • identifying how long a patient has been in pain as opposed to focusing on how much pain that individual is experiencing at a specific time
  • reviewing the need or request for every opioid prescribed after a procedure to reduce the risk of ongoing or persistent use 
  • supporting clinicians in identifying patients at risk of opioid use disorder
  • estimating the oral morphine equivalent dose of the therapy an individual patient is receiving and bring high doses (>100 mg/day) to the attention of the treating physician
  • identifying where co-prescribed medications, such as benzodiazepines and gabapentinoids, may increase the risk of patient harm 
  • supporting appropriate deprescribing of opioids using skills such as motivational techniques
  • supporting and advocating for the role of pharmacy in analgesic stewardship
  • supporting GPs (and their patients) with practical strategies for safe and incremental opioid dose reduction, including staged supply
In Australia, 3.6% of the population surveyed had abused prescription analgesics in the previous 12 months and one in 20 Australians had misused a pharmaceutical drug in this period, accoridng to 2017 Australian Institute of Health and Welfare data, he said.
 
“The majority (52%), prior to the removal of codeine from over the counter, had obtained their pharmaceutical drug from a pharmacy, whereas one in five had obtained this on prescription.”
 
“There is without doubt a role for the appropriate use of opioid analgesia in modern medicine,” Mr Hall said.
 
“In acute and postoperative pain management, short-term use is evidence based, with some surgical procedures not being able to be performed without the use of opioid analgesia.
 
The challenge we face is providing such medications for just long enough’ and not in excess 
just in case’.
 
The duration for which opioids are supplied post-operatively, often to previously opioid-native patients, can have many consequences, not the least of which is increasing the likelihood of misuse and abuse.”
 
Click here to see the full editorial 
 
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