Note: In recognition of National Pain Awareness Month in September, CompleteRx examines pain management in 2020 and in the age of COVID-19.
The COVID-19 pandemic has placed new stressors on those living with pain or substance use disorder. Social isolation, financial concerns, and uncertainty combined with limited access to treatment and recovery services during the pandemic are creating significant challenges for these individuals.
A recent analysis of 500,000 urine drug tests by Millennium Health, a national laboratory service, showed some worrisome trends: an increase of 32 percent for nonprescribed fentanyl, 20 percent for methamphetamine, and 10 percent for cocaine from mid-March – May. In addition, suspected drug overdoses climbed 18 percent in the same period, according to a national tracking system run out of the University of Baltimore.
“Access to services was a big issue in the beginning of the pandemic,” says Jennifer Seagle, CompleteRx area clinical manager. “Many patients temporarily lost access to physical therapy, chiropractic services, massage therapy and those non-pharmacologic avenues used to treat pain. For many, the only thing they had to rely on was their prescribed pain medication.”
After the initial shutdown, access to healthcare services is beginning to improve. Virtual care is more prevalent. And with mask-wearing, social distancing and other safety measures in widespread use, patients living with pain are beginning to feel safer seeking in-person care from their physicians, physical therapists and other providers for pain.
On the legislative front, several new laws have been introduced over the past few years aimed at addressing the opioid epidemic and substance abuse.
Expanding Access to Prevention, Treatment and Recovery
A number of federal laws aimed at curbing the opioid crisis have received support from the pharmacy industry, including drug manufacturers, patient advocates and professional organizations. “A lot of these laws are aimed at expanding access to prevention, treatment and recovery services, and reducing access to opioids,” says Seagle.
Here are a few pieces of legislation introduced in recent years:
- The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018: The legislation expands drug management programs, establishes addition drug review and utilization requirements, and provides coverage for medication-assisted treatment.
- The 21st Century Cures Act: The act elevates leadership and accountability for behavioral health disorders at the federal level, including establishing the position of Assistant Secretary for Mental Health and Substance Abuse.
- The Comprehensive Addiction and Recovery Act (CARA) of 2016: The legislation authorizes funds each year to increase prevention programs and the availability of treatment programs. “CARA helped establish Naloxone treatment programs and made it easier for pharmacists to be able to dispense Naloxone without a doctor’s visit or prescription,” adds Seagle.
- The Prescription Drug Monitoring Act of 2019 has not yet passed the House or Senate. If passed, the legislation would require states to have prescription drug monitoring programs (PDMPs) to help identify and prevent unsafe prescribing practices and doctor shopping.
The Role of the Pharmacist
Hospital pharmacists are uniquely positioned to help address the opioid crisis as the resident medication experts within their facilities. With a deep understanding of Joint Commission standards on pain management, pharmacists take part in pain management opioid stewardship programs and the pharmacy and therapeutics committee. They work to prevent opioid misuse, ensure the appropriate therapeutics are on the formulary, and improve patient outcomes.
Pharmacists monitor drug profiles to ensure appropriate prescribing practices and counsel patients before discharge on appropriate opioid prescription use. Hospitals also task pharmacists with taking an active role in drug therapy management. Pharmacists do this by assessing therapeutic drug levels, patient outcomes and adverse drug events to track potential opioid abuse. By tracking Narcan (naloxone) doses, for example, pharmacy reviews trends and identifies opportunities to improve safety in inpatient prescribing.
To support these efforts, CompleteRx facilitates continuing education programs for pharmacists and pharmacy technicians and nursing and prescriber in-services on pain management standards and best practices. Pharmacists also join patient care rounds to provide guidance on safe opioid dosing and alternative non-opioid pain management therapies .
In addition, robust data and informatics uncover pain medication prescribing and utilization patterns for hospital clients to help drive performance improvement and patient safety. CompleteRx hospital clients benefit from a pain management gap analysis to establish baseline metrics as well as tools to improve Joint Commission compliance and patient safety. Pharmacy also collects and shares pain management metrics, such as morphine equivalents dispensed, opioid orders and reversal agent use, with hospital administration and leadership.
Find out how CompleteRx can support your hospital’s pain management and opioid stewardship efforts. Contact us TODAY.