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Mubarak N, Zahid T, Rana FR, Ijaz UEB, Shabbir A, Manzoor M, Khan N, Arif M, Naeem MM, Kanwal S, Saif-Ur-Rehman N, Zin CS, Mahmood K, Asgher J, Elnaem MH. Are pharmacists on the front lines of the opioid epidemic? A cross-sectional study of the practices and competencies of community and hospital pharmacists in Punjab, Pakistan. BMJ Open 2023; 13:e079507. [PMID: 37989383 PMCID: PMC10668153 DOI: 10.1136/bmjopen-2023-079507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues. STUDY DESIGN A cross-sectional study, conducted across Punjab, Pakistan. METHOD The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists. RESULTS 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents 'never' or 'sometimes' made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, 'opioid overdose management', 'opioid use monitoring' and 'therapeutic uses of opioids'. CONCLUSION Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce.
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Affiliation(s)
- Naeem Mubarak
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Taheer Zahid
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Fatima Rahman Rana
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Umm-E-Barirah Ijaz
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Afshan Shabbir
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Mahrukh Manzoor
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Nahan Khan
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Minahil Arif
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Muhammad Mehroz Naeem
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Sabba Kanwal
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Nasira Saif-Ur-Rehman
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Khalid Mahmood
- University of the Punjab Quaid-i-Azam Campus, Lahore, Pakistan
| | - Javaid Asgher
- Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
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Bagley SM, Northup R, Wason K, Bratberg J, Gordon AJ, Oliva E. Examining Systems, Substance Use, and Disenfranchisement: Overview and Proceedings of the 2022 AMERSA Conference. Subst Abus 2023; 44:4-11. [PMID: 37226906 DOI: 10.1177/08897077231169569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Sarah M Bagley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | | | - Kristin Wason
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island, Kingston, RI, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Vulnerable Veteran Innovative Patient-Aligned-Care-Team, Informatics, Decision-Enhancement and Analytic Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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Axelsson MAB, Lövgren H, Kronstrand R, Green H, Bergström MA. Retrospective identification of new psychoactive substances in patient samples submitted for clinical drug analysis. Basic Clin Pharmacol Toxicol 2022; 131:420-434. [PMID: 36028947 DOI: 10.1111/bcpt.13786] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
New psychoactive substances (NPS) are life-threatening through unpredictable toxicity and limited analytical options for clinicians. We present the retrospective identification of NPS in raw data from a liquid chromatography-high resolution mass spectrometry (LC-HRMS) based multidrug panel analysis on 14,367 clinical oral fluid samples requested during 2019 mainly by psychiatric and addiction care clinics. Retrospectively analysed NPS included 48 notified originally in 2019 by the European Union Early Warning System (EU-EWS) and 28 frequently reported in Sweden. Of 88 included NPS, 34 (mitragynine, flualprazolam, 3F/4F-α-P(i)HP, etizolam, 4F-MDMB-BINACA, cyproheptadine, 5F-MDMB-PICA, isotonitazene, isohexedrone, MDPEP, N-ethylpentedrone, tianeptine, flubromazolam, 4'-methylhexedrone, α-P(i)HP, eutylone, mephedrone, N-ethylhexedrone, 5F-MDMB-PINACA, ADB-BUTINACA, 3-methoxy PCP, 4F-furanylfentanyl, 4F-isobuturylfentanyl, acrylfentanyl, furanylfentanyl, clonazolam, norfludiazepam, 3F-phenmetrazine, 3-MMC, 4-methylpentedrone, BMDP, ethylphenidate, methylone, α-PVP) were identified as 219 findings in 84 patients. Eight NPS notified in 2019 were identified, five before EWS release. NPS occurred in 1.20% of all samples and 1.53% of samples containing traditional drugs, and in 1.87% of all patients and 2.88% of patients using traditional drugs. NPS use was more common in men and polydrug users. Legal (not scheduled) NPS were more used than comparable illegal ones. Retrospective identification could be useful when prioritizing NPS for clinical routine analysis and when studying NPS epidemiology.
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Affiliation(s)
- Magnus A B Axelsson
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Lövgren
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Kronstrand
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Henrik Green
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Moa Andresen Bergström
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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