(1328) Physician-pharmacist Collaboration in Enhancing Opioid Safety: A Systematic Review

Objectives: Opioid misuse and overdose deaths have reached epidemic proportions in the United States (US). There is a need for effective strategies to mitigate opioid-related risks and enhance opioid safety. Healthcare professionals have explored innovative approaches, with one promising avenue being the collaboration between physicians and community pharmacists. Community pharmacists, owing to their expertise in medication management and accessibility to both patients and providers, are well-positioned to participate in opioid safety initiatives. Pharmacist collaboration with physicians can potentially optimize opioid therapy, reduce the risk of opioid misuse, increase access to naloxone and medications for opioid use disorder (MOUD), and improve patient care. In addition, there is evidence that a multi-disciplinary approach involving pharmacists can improve pain management, reduce depression and disability scores, and increase treatment satisfaction among opioid-treated chronic pain patients.
The objectives of this systematic review were to (a) identify and evaluate the existing literature on physician-pharmacist collaboration to reduce opioid-related risks, expand access to naloxone and MOUD, and (b) assess the perceptions of physicians and pharmacists regarding the delivery of collaborative services to improve opioid safety.

Methods: Literature searches were performed across four databases: PubMed, Web of Science, CINAHL, and Google Scholar. Eligible articles included US-based peer-reviewed empirical research conducted between 2002 and 2023, focusing on physician-pharmacist collaboration in providing opioid-related services and their perceptions regarding providing collaborative services. Critical appraisal of included studies was done using the JBI (formerly Joanna Briggs Institute) tool. The review protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42023428099. PRISMA guidelines were followed to report this systematic review.

Results: The search retrieved a total of 523 articles, and 11 met the inclusion criteria. Physician-pharmacist collaborative opioid-related services included engaging with patients to optimize pain management, implementing opioid risk-reduction strategies, and facilitating access to naloxone and medications for opioid use disorder (MOUD). The collaborative model yielded several positive outcomes, including the identification of medication-related problems, pharmacist offering recommendations based on patient medication reviews, utilization of naloxone for overdose reversal, increased rates of MOUD treatment retention and adherence, and enhanced patient satisfaction with the collaborative services.
Findings further demonstrated favorable attitudes from both physicians and pharmacists towards physician-pharmacist collaboration in the prevention of opioid misuse and diversion, as well as expanding access to naloxone and MOUD services. However, pharmacists reported barriers (e.g., lack of a reimbursement model, concerns related to implementation costs) hindering their participation in collaborative interventions. Pharmacists also expressed hesitancy in “questioning” a physician's clinical judgment and faced difficulties in establishing direct communication with providers for clinical discussions. Conversely, physicians reported ease of access to pharmacists for discussions but acknowledged reduced direct communication due to their increased reliance on prescription monitoring programs. Other perceived challenges to collaboration included a lack of trust, stigma surrounding opioid use, and the lack of clearly defined roles and responsibilities, along with differing expectations concerning treatment plans.

Conclusions: Increased collaboration between physicians and community pharmacists in optimizing opioid therapy could enhance patient engagement, contribute to the responsible use of opioids, reduce opioid-related risks, and improve patient safety. This collaborative approach can also foster increased access to naloxone and MOUD and improve patients’ retention and adherence to MOUD. Addressing challenges, such as issues of trust, communication barriers, reimbursement, and the need for clearly defined roles is crucial for the effective implementation of physician-pharmacist collaborative practices in enhancing opioid safety. Future research should focus on strategies to overcome these challenges.