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Hughes TD, Nowak J, Sottung E, Mustafa A, Lingechetty G. Empowering Pharmacists: Strategies for Addressing the Opioid Crisis through a Public Health Lens. PHARMACY 2024; 12:82. [PMID: 38921958 PMCID: PMC11207300 DOI: 10.3390/pharmacy12030082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. RESULTS This commentary examines five determinants of public health in relation to pharmacist-led interventions for the opioid crisis: individual behavior, social factors, policymaking, health service accessibility, and biological/genetic considerations. Pharmacists can influence individual behavior through education and support, address social determinants like stigma, advocate for policy changes, ensure health service accessibility, and personalize opioid prescriptions based on biological factors. CONCLUSION Pharmacists play a crucial role in addressing the opioid crisis by navigating these determinants. Pharmacists' engagement is essential for reducing opioid-related harms and improving public health outcomes through advocacy, service provision, and education.
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Affiliation(s)
- Tamera D. Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (J.N.); (E.S.); (A.M.); (G.L.)
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Hwang S, Hughes TD, Niznik J, Ferreri SP. Association of Average Daily Morphine Milligram Equivalents and Falls in Older Adult Chronic Opioid Users. PHARMACY 2024; 12:62. [PMID: 38668088 PMCID: PMC11054049 DOI: 10.3390/pharmacy12020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
Opioids remain commonly prescribed in older adults, despite the known association with falls and fall-related injuries. This retrospective cohort study sought to determine the association of opioid use and falls in older adult opioid users. Using a one-year lookback period in electronic health records, daily morphine milligram equivalents (MMEs) were calculated using prescription orders. Fall history was based on patient self-reporting. A receiver operating characteristic (ROC) curve was used to identify the threshold of average daily MMEs at which the likelihood of falls was increased. Older opioid users were most often women and White, with 30% having fallen in the prior year. In ROC analyses (n = 590), the threshold where fall risk increased was 37 MMEs (p = 0.07). Older adults prescribed more than 37 MMEs daily may be at increased fall risk and should be targeted for deprescribing interventions. Additionally, analysis on patient characteristics and covariates suggest that sex, age, COPD, sleep apnea, cancer, and psychiatric conditions may indicate an increased risk of falls in older adults taking chronic opioids (p < 0.05). Multifactorial interventions may be needed to modify fall risk beyond medication use alone.
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Affiliation(s)
- Stephanie Hwang
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina, Chapel Hill, NC 27599, USA
| | - Tamera D. Hughes
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina, Chapel Hill, NC 27599, USA
| | - Joshua Niznik
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina, Chapel Hill, NC 27599, USA
- Center for Aging and Health, Division of Geriatric Medicine, School of Medicine, The University of North Carolina, Chapel Hill, NC 27599, USA
| | - Stefanie P. Ferreri
- Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, The University of North Carolina, Chapel Hill, NC 27599, USA
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Langford AV, Schneider CR, Reeve E, Doctor JN, Gnjidic D. Comment on: "Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing". Drugs Aging 2024; 41:77-78. [PMID: 38165603 DOI: 10.1007/s40266-023-01086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/04/2024]
Affiliation(s)
- Aili V Langford
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Emily Reeve
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, California, USA
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Kelley CJ, Niznik J, Busby-Whitehead J, Ferreri SP, Armistead LT, Hughes TD, Henage CB, Schlusser C, Roberts E. Authors' Reply to Langford et al.: "Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing". Drugs Aging 2024; 41:79-80. [PMID: 38165602 DOI: 10.1007/s40266-023-01087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/04/2024]
Affiliation(s)
- Casey J Kelley
- Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Joshua Niznik
- Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA.
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Lori T Armistead
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Tamera D Hughes
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Cristine B Henage
- Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Courtney Schlusser
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ellen Roberts
- Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
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Kelley CJ, Niznik JD, Ferreri SP, Schlusser C, Armistead LT, Hughes TD, Henage CB, Busby-Whitehead J, Roberts E. Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing. Drugs Aging 2023; 40:1113-1122. [PMID: 37792262 PMCID: PMC10768261 DOI: 10.1007/s40266-023-01071-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Opioids and benzodiazepines (BZDs) pose a public health problem. Older adults are especially susceptible to adverse events from opioids and BZDs owing to an increased usage of opioids and BZDs, multiple comorbidities, and polypharmacy. Deprescribing is a possible, yet challenging, solution to reducing opioid and BZD use. OBJECTIVE We aimed to explore older adult patients' knowledge of opioids and BZDs, perceived facilitators and barriers to deprescribing opioids and BZDs, and attitudes toward alternative treatments for opioids and BZDs. METHODS We conducted 11 semi-structured interviews with patients aged 65+ years with long-term opioid and/or BZD prescriptions. The interview guide was developed by an interprofessional team and focused on patients' knowledge of opioids and BZDs, perceived ability to reduce opioid or BZD use, and attitudes towards alternative treatments. RESULTS Three patients had taken opioids, either currently or in the past, three had taken BZDs, and five had taken both opioids and BZDs. Generally, knowledge of opioids and BZDs was variable among patients; yet facilitators and barriers to deprescribing both opioids and BZDs were consistent. Facilitators of deprescribing included patient-provider trust and slow tapering of medications, while barriers included concerns about re-emergence of symptoms and a lack of motivation, particularly if medications and symptoms were stable. Patients were generally unenthusiastic about pursuing alternative pharmacologic and non-pharmacologic alternatives to opioids and BZDs for symptom management. CONCLUSIONS Our findings indicate that patients are open to deprescribing opioids and BZDs under certain circumstances, but overall remain hesitant with a lack of enthusiasm for alternative treatments. Future studies should focus on supportive approaches to alleviate older adults' deprescribing concerns.
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Affiliation(s)
- Casey J Kelley
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Joshua D Niznik
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA.
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA.
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Courtney Schlusser
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lori T Armistead
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Tamera D Hughes
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Cristine B Henage
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
| | - Ellen Roberts
- Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, 5003 Old Clinic, CB# 7550, Chapel Hill, NC, 27599, USA
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Sanders KA, Wolverton D, Stamopoulos M, Zunich R, Niznik J, Ferreri SP. An EHR-based method to structure, standardize, and automate clinical documentation tasks for pharmacists to generate extractable outcomes. JAMIA Open 2023; 6:ooad034. [PMID: 37181730 PMCID: PMC10174697 DOI: 10.1093/jamiaopen/ooad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023] Open
Abstract
As the recognition of team-based care grows and pharmacists increase in patient care interventions, it is important that tools to track clinical services are easily accessible and well-integrated into workflow for all providers. We describe and discuss feasibility and implementation of data tools in an electronic health record to evaluate a pragmatic clinical pharmacy intervention focused on deprescribing in aged adults delivered at multiple clinical sites in a large academic health system. Of the data tools utilized, we were able to demonstrate clear documentation frequency of certain phrases during the intervention period for 574 patients receiving opioids and 537 patients receiving benzodiazepines. Although clinical decision support and documentation tools exist, they are underutilized or cumbersome to integrate into primary health care and strategies, such as employed, are a solution. This communication incorporates the importance of clinical pharmacy information systems in research design.
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Affiliation(s)
- Kimberly A Sanders
- Corresponding Author: Kimberly A. Sanders, PharmD, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, 301 Pharmacy Lane, Campus Box 7574, Chapel Hill, NC 27599-7574, USA;
| | - Daniel Wolverton
- Department of Pharmacy, UNC Health, Chapel Hill, North Carolina, USA
| | | | - Rada Zunich
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Joshua Niznik
- Division of Geriatrics and Center for Aging and Health, Division of Pharmaceutical Outcomes and Policy, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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Niznik JD, Hughes T, Armistead LT, Kashyap J, Roller J, Busby-Whitehead J, Ferreri SP. Patterns and disparities in prescribing of opioids and benzodiazepines for older adults in North Carolina. J Am Geriatr Soc 2023; 71:1944-1951. [PMID: 36779609 PMCID: PMC10258120 DOI: 10.1111/jgs.18288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND We characterized real-world prescribing patterns of opioids and benzodiazepines (BZDs) for older adults to explore potential disparities by race and sex and to characterize patterns of co-prescribing. METHODS A retrospective evaluation was conducted using electronic health data for adults ≥65 years old who presented to one of 15 primary care practices between 2019 and 2020 (n = 25,141). Chronic opioid and BZD users had ≥4 prescriptions in the year prior, with at least one in the last 90 or 180 days, respectively. We compared demographic characteristics between all older adults versus chronic opioid and BZD users. We used logistic regression to identify characteristics (age, sex, race, Medicaid use, fall history) associated with opioid and BZD co-prescribing. RESULTS We identified 833 (3.3%) chronic opioid and 959 chronic BZD users (3.8%) among all older adults seen in these practices. Chronic opioid users were less likely to be Black (12.7% vs. 14.3%) or other non-White race (1.4% vs. 4.3%), but more likely to be women (66.8% vs. 61.3%). A similar trend was observed for BZD users, with less prescribing among Black (5.4% vs. 14.3%) and other races (2.2% vs. 4.3%) older adults and greater prescribing among women (73.6% vs. 61.3%). Co-prescribing was observed among 15% of opioid users and 13% of BZD users. Co-prescribing was largely driven by the presence of relevant co-morbid conditions including chronic pain, anxiety, and insomnia rather than demographic characteristics. CONCLUSIONS We observed notable disparities in opioid and BZD prescribing by sex and race among older adults in primary care. Future research should explore if such patterns reflect appropriate prescribing or are due to disparities in prescribing driven by biases related to perceived risks for misuse.
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Affiliation(s)
- Joshua D Niznik
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
- UNC Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
- Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Tamera Hughes
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Lori T Armistead
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Jayanth Kashyap
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Roller
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
- UNC Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
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