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Establishing professional relationships: exploring a new guideline for opioid medications

July 20, 2017

The new ACP opioid guidelines for pharmacy professionals come into effect October 1, 2017. To prepare, pharmacists should review the five key areas from the guidelines against their current practices and identify gaps or areas for improvement. 

Over the next few weeks, we’ll take a closer look at each of the five key areas, starting with:

Pharmacists must establish and maintain a professional relationship with each individual using opioid medications.

Opioid therapy management presents challenges for pharmacists due to the complex nature of the underlying conditions and the risks of addiction. Critical to the success of patient assessment is building and maintaining a professional relationship with your patients (or their caregivers). What does this look like? The first step is to speak with your patients, their agent, or caregiver directly. Pharmacy technicians play a vital role in the dispensing process, but only a pharmacist can assess the patient. 

Tip: You can use ACP’s Chat Check and Chart – Vital to Patient Care tool card to learn more about how to connect with your patients.

The pharmacist MUST identify the health priorities of the individual and work with them to set realistic expectations for pain management.

It’s critical that the pharmacist understands what the patient knows about their medication and their condition to help them manage their expectations. Ask open-ended questions about what they are using the medication for and what they hope to gain from its use.

The pharmacist must work to build and maintain rapport with individuals and avoid assumptions or stereotypes.

“Gaining the trust of your patients is essential to assessing their health needs and your ability to monitor therapy at future visits,” advises Monty Stanowich, ACP Compliance Officer. “This means being honest and forthright with these patients and avoid judging them based on appearance or mannerisms. These individuals come from all walks of life and anyone using an opioid may develop a dependency to the drug. Remember that this is a well-known risk of these medications and does not represent a character flaw of the patient.”

The pharmacist must help individuals to understand that opioid medications are not a cure for their condition. Let individuals know to expect a mild to moderate reduction in pain and increase in function.

It’s important to emphasize that opioid medications help to treat pain and are never a “cure” for anything.

  • For acute or short-term pain, advise your patients that the medication should be used conservatively and they must never exceed the dose or duration indicated by the prescriber. If they find the dose they are using is insufficient, you should collaborate with their prescriber and/or refer the patient.
  • For chronic pain, patients should be told to expect a mild to moderate decrease in chronic pain and increase in function. Clinically meaningful improvement has been defined as a 30 per cent improvement in scores for both pain and function.[1] Connect with individuals at the onset of their treatment to establish baseline data and then continually re-evaluate as treatment progresses.
The pharmacist must make individuals aware of the risks of opioids including tolerance, dependence, overdose, addiction, and adverse effects such as sedation which can affect their quality of life. Ensure that individuals fully understand the risks and benefits of using opioids.

“Opioids carry a significant risk for harm. Ensure that individuals prescribed opioids understand that the benefits of pain relief and improved function need to be balanced against their risk of developing tolerance, dependence, and addiction,” Monty adds. “This risk is individualized. There are simple tools you can use such as the Cage assessment and Opioid Risk Tool that aid in predicting the relative risk of developing these drug related problems.”

Watch for more articles on the remaining four key areas in upcoming weeks.

 Read the guidance

Originally published in the July 20, 2017, issue of The Link