Survey of Opioid Stewardship Practices in American Society of Health-System Pharmacists (ASHP) Post-Graduate Year 2 (PGY2) Pain Management and Palliative Care (PMPC) Pharmacy Residency Programs

Abstract

Opioid analgesics, such as morphine and oxycodone, are frequently prescribed for pain management. Widespread prescribing and misinformation about the habit forming potential of opioids have contributed to the increase of preventable morbidity and mortality in the last two decades. This led to the declaration of a public health emergency in the United States in October of 2017 (1). Over 67,000 people died of drug overdose in 2018, with opioids being involved in 69.5% of them (2). The economic burden of prescription opioid abuse is also substantial, with approximately $78.5 billion per year being spent toward healthcare costs, addiction treatment, and criminal justice costs, among other expenses (2–3). The opioid epidemic has resulted in increased emphasis on stewardship practices within the healthcare system. Opioid stewardship, while having no formal definition thus far, has been described as “a set of interventions implemented to improve prescribing, mitigate adverse events, and monitor the use of opioids” (4). The Institute for Safe Medication Practices Canada (ISMP Canada) provides a similar definition of “coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health (5). In 2018, The Joint Commission implemented new standards for accredited hospitals, focusing on safe opioid prescribing and monitoring of patients (6). Many key principles of opioid stewardship are reflected in these standards, including the need for a leadership team and availability of nonpharmacological treatments. The standards also emphasized the need for creating and analyzing quality improvement metrics to increase patient safety, and monitoring opioid use, adverse events and prescribing. The comprehensive approach outlined by The Joint Commission provides a framework for accredited hospitals to develop opioid stewardship protocols and practices. Pharmacists have been identified as a member of the multidisciplinary healthcare team that can further the goals of opioid stewardship (7). Pharmacists can obtain specialized training in pain management and palliative care to further become subject matter experts in the pharmacology and treatment of pain syndromes. There are currently 26 Post Graduate Year 2 (PGY2) Pharmacy Residency programs specializing in Pain Management and Palliative Care (PMPC) accredited by the American Society of Health Systems Pharmacists (ASHP), which train pharmacists to integrate into the healthcare team and contribute to complex treatment regimens (8). Poirier et al. (9). showed benefit in multiple areas after implementation of a pharmacist-directed pain management service. Patient satisfaction scores improved alongside a decrease in overall opioid utilization, decrease in opioid-induced rapid response team (RRT) events, and estimated annual indirect cost avoidance of $1.5 million to $1.8 million per year. Given the benefits of opioid stewardship reported in literature, this editorial aims to describe the current state of integration of opioid stewardship within the active accredited ASHP PGY2 PMPC Pharmacy Residency programs.