(1325) Implementing an Opioid Pledge in a Community-based Independent Pharmacy

Objectives: The objective of this project is to implement a safe opioid dispensing service for patients who receive chronic opioid medications by obtaining a signed opioid pledge from these patients. Secondary objectives are to quantify the number of signed opioid pledges, measure the change in morphine milligram equivalents, and quantify financial reimbursement opportunities resulting from dispensing a naloxone prescription and billing for the consultation with patients. The opioid epidemic is affecting the community locally, state-wide, and nationally. The number of drug overdose deaths has quintupled since 1999. In the year 2020 alone, approximately 75% of drug overdose deaths were attributed to opioids. Current strategies used by community-based pharmacies to fight the opioid epidemic include utilizing prescription drug monitoring programs, observing for signs of opioid misuse, and inappropriate prescribing of opioids or unsafe medication combinations prescribed. Advanced strategies could include monitoring trends to better understand patients, supporting providers with information about patients and their usage, and increasing patient awareness through a patient “opioid pledge.” The idea for implementing an opioid pledge has been adapted from the Community Pharmacy Enhanced Services Network’s Flip the Pharmacy initiative. Their resources highlight the importance of this program and emphasize the positive role pharmacists can play in this crisis.

Methods: This study will be implemented at two independent pharmacy locations in the southeastern United States. Individuals are eligible for inclusion if they are 18 years of age or older, a current patient of either pharmacy, and received an opioid product for three or more consecutive months in 2023. Individuals will be excluded if they are less than 18 years of age or a pet.

The pharmacy software will be used to identify eligible patients. Alerts will be added to each eligible patient’s pharmacy profile to notify the pharmacist that a letter detailing the program should be provided to the patient. The letter will have a project description, the importance of an opioid pledge, and a QR code that takes the patient to a form to fill out for pharmacy use. The online form will request patient medications, conditions, contact information, a preferred time to contact to do the virtual consultation, and signature. Prior to the patient consultation, a pharmacist will review the patient’s complete medication profile, reference the prescription drug monitoring program, and evaluate the patient’s candidacy for naloxone.

Next, the pharmacist will perform a consultation with the patient regarding opioid safety. Topics discussed would include drug-drug or drug-disease interactions, calculated morphine milligram equivalents, the signed opioid pledge and expectations from the patient and pharmacy, offer a naloxone prescription, discuss methods of safe medication disposal, and respond to any patient questions or concerns. The signed opioid pledge will be scanned and the encounter will be documented into their profile.

Collected data points will include signed opioid pledge (yes/no), morphine milligram equivalents at enrollment, morphine milligram equivalents at project conclusion, naloxone dispensed (yes/no), time spent on data collection, and time spent on consult. Descriptive statistics will be used to analyze results.

Results: Data collection will occur between October 2023 through January 2024. Preliminary analysis indicates approximately 140 patients eligible for inclusion. Data will be analyzed in February 2024.

Conclusions: This project could benefit any community-based pharmacy since it leverages a method that can legally protect the pharmacy amid the opioid epidemic. Additionally, it protects patients by providing education and resources. By implementing this service, we hope to make a positive impact on patients that participate by increasing their understanding of the dangers of opioids, the significance, and if applicable, help them titrate down on morphine milligram equivalents.