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The Washington State Pharmacist Perspective

The Washington State Pharmacist Perspective. Jenny Arnold, PharmD , BCPS Director of Pharmacy Practice Development Washington State Pharmacy Association. Objectives. Describe Washington State’s Opiate Deaths Discuss the Scope of Practice of Pharmacy

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The Washington State Pharmacist Perspective

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  1. The Washington State Pharmacist Perspective Jenny Arnold, PharmD, BCPS Director of Pharmacy Practice Development Washington State Pharmacy Association

  2. Objectives • Describe Washington State’s Opiate Deaths • Discuss the Scope of Practice of Pharmacy • Explain Collaborative Practice Agreements • Analyze the challenges of initiating a CPA • Examine alternatives for pharmacy involvement

  3. Opioid Sales in WA State, Estimated # daily doses sold annually Methadone does not include methadone dispensed by narcotic treatment programs. Methadone data provided by DEA for 2007-2010 included narcotic treatment programs, estimates removing expected NTP use are shown with a dashed line Source: Drug Enforcement Administration Automation of Reports and Consolidated Orders System, data include medications prescribed and dispensed. Data provided to and analyzed by Caleb Banta-Green Alcohol & Drug Abuse Institute, University of Washington Defined Daily Dose utilized from WHO http://www.whocc.no/atcddd/

  4. Outpatient, Inpatient, MMT, • At the population level rx opiate abuse appears to precede heroin abuse • King county data show that 40% of heroin users were “hooked on” Rx opiates first

  5. Unintentional prescription opioid involved overdose deaths Washington 1995-2008 Surpassed traffic fatalities Source: Washington State Department of Health, Death Certificates, Jennifer Sabel, PhD

  6. Medic One Responses 32 cardiac arrest cases per month responded to by SFD in 2010** 45 serious opiate overdoses per month responded to by SFD in 2011* • Approximately 1:1 Heroin:Rx Opiate *268 serious opiate overdoses per our chart abstraction for 6 months in 2011 ** “384 out of hospital cardiac arrest cases treated by SFD in 2010”

  7. Source: King County Medical Examiner Public Health- Seattle & King County

  8. Source: King County Medical Examiner Public Health- Seattle & King County

  9. Opioid Overdose Risk by Average Daily Dose of Prescribed Opioids Received

  10. Pharmacists • Doctor of Pharmacy Degree is now the minimum degree to enter practice. • This entails normally 7 years minimum of education • Pharmacists are the medication experts in healthcare • Post graduate training opportunities include residencies and fellowships.

  11. Pharmacists as Mid-level Prescribers • Dependent prescribing • Collaborative Prescriptive Agreements • Similar to PA’s • The laws vary in in each state.

  12. Collaborative Prescriptive Agreements • A legal agreement between a prescriber and pharmacist • Agreement must list: • Where and who • Which drugs or diseases • Policies and procedures • Liability insurance • RI Pharmacy Laws Section 25.0

  13. Pharmacist Participating in CPA in RI • A pharmacist participating in CPA must • Have post graduate training/experience • Access to patient information • 5 hours of CE in the area each year

  14. Washington State

  15. Washington Model • Public Health- Seattle & King County began distributing in February in 2012 • Recruitment via needle exchange • OD prevention and intervention training at Needle Exchange • Narcan prescribing and dispensing by Public Health pharmacist • CPA facilitates this • Police training video recently released based on survey findings

  16. Expanded Washington Model • Partnering with Community Pharmacies • Target those either at risk of having, or witnessing an overdose • Utilizing web based patient education and other handouts to limit impact on pharmacist time

  17. Opportunities to engage pharmacists • Show the pharmacists what their practices will look like if they prescribe and dispense naloxone • Screening forms • Example CPA • Physician Partners to sign CPAs and refer patients • Education – make the pharmacists the experts in naloxone • Resources and references for questions and further education • Students • Teach this material in schools, so that students come out expecting to do this • Partner with faculty members to include in curriculum

  18. Challenges • Evolution of pharmacy practice • Pharmacists can be black and white • Medicaid coverage

  19. Other ways pharmacy can help • Stock Naloxone injections or kits • Cash payment • Overdose education, especially to patients on more than 100 morphine equivalents daily • Other Public Health Opportunities • Immunizations • Emergency Response

  20. Questions?

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