During the COVID-19 pandemic, the opioid crisis has continued unabated. Deaths in Alberta due to opioid poisoning that were trending downward in 2019 spiked up to an all-time high of 1,331 in 2020. There are no signs of slowing down—488 people died from opioid poisoning through the first four months of 2021[1].
Pharmacists and pharmacy technicians play key roles in the opioid crisis, not the least of which is the provision of opioid agonist therapy (OAT) to individuals seeking medical care for opioid use disorder (OUD). In the last five years (2016-2021), there has been a substantial increase in the number of individuals dispensed an opioid medication in Alberta, including the following:
- 85 per cent increase in individuals using methadone, and
- 541 per cent increase in individuals receiving Buprenorphine/naloxone.
In addition, new treatments such as slow-release oral morphine, injectable OAT, naltrexone, and others have emerged.
Seventy-three per cent of licensed community pharmacies have indicated to ACP that they provide OAT services. Of Alberta’s more than 1,500 licensed community pharmacies, nearly 1,300 are registered to provide AHS naloxone kits. Between 2016 and 2020, 98,769 AHS naloxone kits were dispensed from community pharmacies.
To support pharmacy professionals in addressing this public health crisis, ACP’s Opioid Agonist Therapy (OAT) guidelines have been completely redeveloped and will officially come into force on July 1, 2021. These guidelines will ensure that regulated members who provide OAT services are up to date with how patient care should be delivered. These new guidelines will replace the Medication-assisted Treatment for Opioid Dependence (ODT) Guidelines.
The OAT guidelines include updated terminology for the treatment of OUD to minimize confusion and make a distinction between opioid dependence and the use of illicit opioids or non-prescribed use of prescription opioids. The guidelines no longer use pharmacy-centric language that may be considered paternalistic and stigmatizing.
The revised guidelines focus on regulatory and technical information and include direction on the use of naloxone as a tool to treat opioid poisoning. For current clinical information, the guidelines direct regulated members to external resources.
When you refer to the OAT guidelines, you’ll notice that they are divided into two parts: Part A and Part B. Regulated members will read Part A—Meeting the needs of individuals with OUD—before proceeding to Part B—Guidelines for pharmacists and pharmacy technicians providing care for patients using opioid agonist therapy.
Part A
Part A discusses key concepts and expectations on how patient care should be delivered to individuals with OUD. This part creates the lens through which Part B of the guidelines should be considered and applied.
All regulated members should familiarize themselves with the following concepts and apply them as they interpret the entirety of the guidelines and apply the guidelines while they provide care to their patients.
Stigma
Whether intentional or not, stigma can come in many forms, including discrimination, prejudice, judging, labelling, isolating, and stereotyping. When people feel stigmatized, it can prevent them from getting the help they need, creating barriers to accessing important health and social services.
Trauma-informed care
Trauma-informed care is a set of guiding principles which considers the effects of trauma on an individual. Psychological trauma is often closely associated to substance use, with responses varying from minor disruptions to their personal life to a debilitating response. Trauma-informed care recognizes the link between substance use and trauma, and ensures people feel safe and not re-traumatized by their care.
Harm reduction
Harm reduction is an approach to care that focuses on meeting people where they are and reducing the harm of the use of legal and illegal psychoactive substances without necessarily reducing consumption. It’s about recognizing the inherent value of human beings and supporting people who use substances with compassion.
Regulated members must understand and accept, without applying moral judgements, that individuals with substance use disorders need to be treated with the same level of respect as all other patients.
Part B
Part B are the technical and regulatory guidelines for pharmacists and pharmacy technicians providing care for patients using OAT. This part includes guidance on the following:
- strategy for medication-assisted treatment of OUD,
- licensee and regulated member responsibilities,
- collaboration with the prescriber and other members of the patient’s healthcare team,
- prescription standards and requirements,
- OAT general guidelines,
- buprenorphine-naloxone,
- alternative buprenorphine treatments
- methadone,
- alternative approaches to the treatment of OUD, and
- additional clinical scenarios involving OAT.
Part B also features additional resources and tools for pharmacy teams providing OAT to patients. As clinical information is no longer part of the revised guidelines, these resources include external references for current clinical information. ACP encourages all registrants to familiarize themselves with the OAT guidelines and ensure compliance beginning July 2, 2021.
We’ll have a more in-depth look at OAT and OUD in an upcoming edition of ACP Full Scale later this summer.
