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Anwar A, Malik N, Siddiqui A, Shrestha S, Bhutta OA, Mazhar S, Khan MR, Usman HM. Examining clinical pharmacist interventions and identifying opioid medication-related issues in patients with cancer. J Oncol Pharm Pract 2024:10781552241279027. [PMID: 39196917 DOI: 10.1177/10781552241279027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
INTRODUCTION Opioid medications are crucial for managing pain among patients with cancer. Yet, inappropriate prescribing and medication issues can compromise patient safety and quality of care. Clinical pharmacists play a significant role in optimizing opioid therapy and addressing issues related to opioid medication use. OBJECTIVES This study aimed to examine clinical pharmacist interventions and identify opioid medication-related issues in patients with cancer. METHOD We conducted a retrospective observational study at Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan, conducting a chart review from 1st July 2021 to 31st December 2021. RESULTS Out of 10,534 opioid medication orders, we documented a total of 974 interventions based on our inclusion criteria. Tramadol and morphine accounted for most of these interventions, comprising 49.27% (n = 475) and 40.04% (n = 386), respectively. Regarding clinical significance, 41.70% (n = 406) were deemed significant, while 37.36% (n = 365) were somewhat significant. The majority of interventions, i.e., 54.05% (n = 521), primarily aimed at optimizing patient outcomes, followed by a secondary aim of improvements in communication, i.e., 25.52% (n = 246). CONCLUSION This study establishes the evaluation of clinical pharmacist interventions on opioid medication use in patients with cancer, an issue particularly in oncology settings in Pakistan. The findings emphasize the crucial role of clinical pharmacists in addressing issues related to opioid issue medications, thus improving patient safety and optimizing opioid use for patient well-being.
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Affiliation(s)
- Amjad Anwar
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Nirmal Malik
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Adeel Siddiqui
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia
- Department of Research and Academics, Kathmandu Cancer Center, Tathali, Nepal
| | - Omar Akhlaq Bhutta
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Saba Mazhar
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Muhammad Rehan Khan
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Hafiz Muhammad Usman
- Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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Harbell MW, Cohen J, Balfanz G, Methangkool E. Mitigating and preventing perioperative opioid-related harm. Curr Opin Anaesthesiol 2024:00001503-990000000-00225. [PMID: 39247993 DOI: 10.1097/aco.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW Although necessary for treatment of acute pain, opioids are associated with significant harm in the perioperative period and further intervention is necessary perioperatively to mitigate opioid-related harm. RECENT FINDINGS Opioid-naive patients are often first exposed to opioids when undergoing surgery, which can result in significant harm. Despite their benefits in reducing acute postsurgical pain, they are also associated with risks ranging from mild (e.g., pruritis, constipation, nausea) to potentially catastrophic (e.g. opioid-induced ventilatory impairment, respiratory depression, death). Overprescribing of opioids can lead to opioid diversion and drug driving. In this review, we will discuss opioid-related harm and what strategies can be used perioperatively to mitigate this harm. Interventions such as optimizing nonopioid analgesia, implementing Enhanced Recovery after Surgery programs, effective respiratory monitoring, patient education and opioid stewardship programs will be discussed. SUMMARY We will review policy and guidelines regarding perioperative opioid management and identify challenges and future directions to mitigate opioid-related harm.
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Affiliation(s)
- Monica W Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Jonathan Cohen
- Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida
| | - Greg Balfanz
- Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Emily Methangkool
- Department of Anesthesiology, Olive View-UCLA Medical Center, Los Angeles, California, USA
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Cramer T. Maximizing opioid stewardship through fentanyl vial size optimization in an independent hospital. Am J Health Syst Pharm 2024; 81:476-478. [PMID: 38430120 DOI: 10.1093/ajhp/zxae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Indexed: 03/03/2024] Open
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Jadhari R, Pathak N, Shrestha R, Shrestha S, KC B, Gan SH, Paudyal V. Advancing opioid stewardship in low-middle-income countries: challenges and opportunities. J Pharm Policy Pract 2024; 17:2345219. [PMID: 38845626 PMCID: PMC11155429 DOI: 10.1080/20523211.2024.2345219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
The increased utilization of opioids in low- and middle-income countries (LMICs) presents a growing threat of opioid-related abuse, misuse and diversion. Pharmacists, as integral members of healthcare teams, are responsible for dispensing and monitoring opioid use and hold a pivotal role in opioid stewardship within LMICs. This commentary describes the potential and multifaceted roles of pharmacists in opioid stewardship in resource-constrained settings and highlights appropriate strategies for promoting responsible opioid utilization. Opioid stewardship involves prioritising evidence-based prescribing, management and practices for pain management. It includes measures such as incorporating prescription drug monitoring programmes for appropriate opioid prescription, implementing safe disposal through drug take-back programmes, promoting non-opioid pain management, addressing the opioid addiction stigma, tapering opioid dose, educating patients and caregivers, establishing drug information centers, providing rehabilitative services and integrating collaboration with communities and experts. The combined difficulties of restricted access to healthcare resources and services coupled with low levels of literacy worsen the susceptibility to opioid abuse, misuse, and diversion in LMICs. Early detection, assessment and implementation of interventions to optimise opioid use are imperative for ensuring safe and effective opioid utilization, thereby mitigating the risks of overdose and addiction. The involvement of pharmacists in promoting safe and effective opioid utilization through education, monitoring, collaboration, and policy advocacy serves as a critical component in bridging existing gaps in opioid stewardship within LMICs.
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Affiliation(s)
- Rojita Jadhari
- Drug Discovery and Development, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Nabin Pathak
- Drug Information Unit and Pharmacovigilance Cell, Department of Pharmacy, Hetauda Hospital, Madan Bhandari Academy of Health Sciences, Bagmati Province, Makwanpur, Hetauda, Nepal
- Department of Pharmacy and Clinical Pharmacology, Madan Bhandari Academy of Health Sciences, Bagmati Province, Makwanpur, Hetauda, Nepal
| | - Rajeev Shrestha
- Palliative Care and Chronic Disease, INF Nepal Green Pastures Hospital and Rehabilitation Centre, Pokhara, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Bhuvan KC
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Siew Hua Gan
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Vibhu Paudyal
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Shrestha R, Shrestha S. Addressing the Critical Gap: Ensuring Urgent Access to Palliative Care Services with Essential Medications in Nepal. J Pain Palliat Care Pharmacother 2024; 38:170-179. [PMID: 38441942 DOI: 10.1080/15360288.2024.2320384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/10/2024] [Indexed: 05/01/2024]
Abstract
Palliative care is essential for life-threatening illnesses. However, Nepal still faces significant challenges in accessing primary palliative care services, including required medications, particularly in rural areas. This commentary highlights the need for policies and guidelines to ensure equitable access to palliative care with medicines. While limited studies in Nepal confirmed the demand, challenges persist in rural areas with deficient access to quality healthcare. This article discusses the existing efforts and noteworthy initiatives implemented by healthcare institutions. However, these efforts are currently limited in scale. We recommend including essential palliative care medicines in government healthcare policies, establishing training programs for healthcare professionals, and developing comprehensive policies with detailed field research work to meet the growing demand. Addressing these issues will significantly improve the quality of life for palliative care patients in Nepal.
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Affiliation(s)
- Rajeev Shrestha
- Chronic Disease and Palliative Care, INF Nepal Green Pastures Hospital and Rehabilitation Center, Pokhara, Province Gandaki, Nepal
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Perlov NM, Shah SS, Bluj J, Urdang ZD, Chiffer RC. The Effect of Postoperative Naloxone in Certain Otolaryngologic Surgeries. Otolaryngol Head Neck Surg 2024; 170:1289-1295. [PMID: 38123881 DOI: 10.1002/ohn.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/12/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate the association of postoperative naloxone with the development of new substance use disorder (SUD), overdose, and death within 6 months of otolaryngologic surgery. STUDY DESIGN Retrospective cohort database study on TriNetX. METHODS Adult patients who underwent tonsil surgery (noncancerous), thyroid/parathyroid, septorhinoplasty, otology/neurotology, sinus/anterior skull base, and head and neck cancer surgeries between January 2003 and April 2023. Patients were excluded if they had an instance of SUD or overdose recorded in their charts prior to surgery, or had undergone another surgery within that 6-month time frame. We hypothesized that patients prescribed naloxone postoperatively would have decreased odds for experiencing new SUD, overdose, and/or death within 6 months of surgery compared to patients who did not receive naloxone. P < .01 was considered statistically significant. RESULTS There were 2,305,655 patients in this study. The average age was 36.7 ± 19.5 years old, with 46% female patients. Before matching, cohorts showed equivocal odds for developing new SUD, increased odds for overdose, and mixed odds for dying. After matching for demographic variables and comorbidities such as other substance use, opioid use for other pathologies, and psychiatric conditions, these effects diminished (P > .01). CONCLUSION Our results suggest that postoperative naloxone may not significantly affect development of new SUD and incident overdose and death in certain otolaryngologic surgeries after controlling for prior SUD and psychiatric conditions. Clinicians should be aware of these comorbidities when considering their postoperative pain management protocol, which may or may not include naloxone.
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Affiliation(s)
- Natalie M Perlov
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sohan S Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joann Bluj
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Zachary D Urdang
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca C Chiffer
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Baumann L, Bello C, Georg FM, Urman RD, Luedi MM, Andereggen L. Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors. Curr Pain Headache Rep 2023; 27:437-444. [PMID: 37392334 PMCID: PMC10462493 DOI: 10.1007/s11916-023-01127-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. RECENT FINDINGS This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.
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Affiliation(s)
- Livia Baumann
- Department of Anaesthesiology and Pain Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Filipovic Mark Georg
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Markus M Luedi
- Faculty of Medicine, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St, Gallen, St. Gallen, Switzerland
| | - Lukas Andereggen
- Faculty of Medicine, University of Bern, Bern, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
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