While planning this business, a lot of our colleagues and friends asked how the opiate crises would play a role in shaping our pharmacy. It is a multifaceted issue that we as pharmacists must navigate every single day, but one that we can now can impact more than ever as business owners. While the media covers this topic constantly, very rarely do we take the opportunity to open up a two-sided discussion. Part of the conversation must be to come up with solutions letting people taking opiates for legitimate pain exist in this healthcare landscape. We have seen over the years many of our patients with disease states resulting in chronic pain get caught in the crossfire between changing legislation and the reaction of their healthcare team. Why should the fear of this conversation result in drastic decisions and suboptimal outcomes for our patients? This we week we would like to discuss how Front Range would like to help our community discover a better path to wellness in the turmoil of the opiate crisis.
Our nation has recently opened its eyes to opiate abuse and misuse, and we can’t ignore the fact that over 130 people die daily from an opiate related drug overdose. Absolutely, our country must address the flood of these medications into hands that have no medical indication for them. The result of the negative press and statistical onslaught, has been legislation changes on state and federal levels. Thankfully, we now have limits on initial prescribing, state-wide data bases reflecting individual use, and easy access to the opiate reversal drug, naloxone. Historically, believe it or not, there hasn’t been much guidance or standardization for prescribing these medications, resulting in several approaches regarding care practices and prescribing. Across the US, and even across individual states, this resulted in patients getting a different standard of care depending on which doctor they saw. Patients with the same diagnosis received vastly different medication doses and were placed on inconsistent drug combinations all with unique pre-existing health conditions. Most legislation passed was at least state-wide and leaves out the individual needs the prior landscape created. Everyday we as pharmacists see patients that are struggling to exist in these new protocols. They are afraid to speak up about their new regimen or health concerns for fear of being labeled as an abuser. How is this healthcare? Why can’t every single patient be given a voice in their pain management path? America will benefit from analyzing pain management and opiate prescribing, but we cannot limit our perspective by only viewing abuse potential and forget that the treatment of pain is a legitimate part of healthcare.
It is hard to describe the wave of anxiety that rushes over patients when giving their pharmacy chronic pain prescriptions. Most of these patients have had a long, hard battle with painful disease states and ultimately must turn to their healthcare team in search of a normal life. Everyday people must depend on a lot of medications to live normally, not just opiates. Opiate dependency is not abuse, it is the result of being treated for chronic pain. Unfortunately, beginning treatment involving opiates results in many patients feeling stereotyped- they fear having friends or relatives find out what they are taking and being called an addict. They’ve had both doctor’s offices and pharmacies treat them with suspicion and are conditioned to talk less and less about their needs related to their opiate medications. In reality, an opiate medication’s effectiveness wanes over time and most people with chronic pain conditions will need to be titrated up from their starting doses to receive the same relief. This is especially difficult for those with cancer-related or severe chronic pain because their dose doesn’t ever get smaller unless their disease resolves. Conversely there are patients that have been mismanaged and end up on dosages much higher than needed. Each day in the pharmacy, we see a spectrum of patients being prescribed these medications. Pharmacists most definitely see abusers, but we also serve patients that are on these medications legitimately. So how can the solution to Amercia’s crisis be a one-size-fits-all model? Patients need advocates in seeking wellness, even in pain management. Front Range promises to step into the void and help to create a treatment plan unique to you.
Our community is in need of a pharmacy where patients can finally be comfortable speaking up about their medication, especially opiates. While it is not up to your pharmacist to decide your health plan, we can do a better job of filling in the gaps and supporting our patients through potential or inevitable changes. Common mistakes made while optimizing pain regimens are titrating too aggressively, not equipping patients with supplemental medications to handle the differences, and being too committed to a particular timeline – your pharmacist can intervene in all of these. We are trained on appropriate dose increases and decreases and can vigilantly monitor your therapy based on what we see and pause to ask how you feel. Too many times do we have patients on a course to lower their medication but not equipped with supplemental therapies to help with agitation, sleep loss, and blood pressure swings – this takes a simple phone call to fix. We understand that dose increases and the initiation of opiates also mandate discussions with your pharmacist. Instead of shaming you into buying naloxone and pushing you out the door, we can sensitively talk about the insurance that is opiate reversal and your decision to keep it in your home. We are here to ensure you are given every opportunity to avoid unwanted side effects so you can continue to be successful in treating your pain and living normally. We will always encourage you to reach out when you feel overwhelmed or unsure about the direction your health plan is taking you. Front Range Pharmacy is being built on the idea that your healthcare is a priority regardless of affliction- that no matter what therapies you might be on, your voice is always included. We will do our part in combating the opiate crisis, but we promise to not compromise your quality of life in our efforts. We hope to eliminate the stigma behind any healthcare issue you have, and that your local pharmacy is always a place where you feel comfortable and empowered.