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

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Presentation on theme: "The Washington State Pharmacist Perspective Jenny Arnold, PharmD, BCPS Director of Pharmacy Practice Development Washington State Pharmacy Association."— Presentation transcript:

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

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3 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

4 Methadone does not include methadone dispensed by narcotic treatment programs. Methadone data provided by DEA for 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 Opioid Sales in WA State, Estimated # daily doses sold annually

5 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 Outpatient, Inpatient, MMT,

6 Source: Washington State Department of Health, Death Certificates, Jennifer Sabel, PhD Surpassed traffic fatalities

7 Medic One Responses 45 serious opiate overdoses per month responded to by SFD in 2011* Approximately 1:1 Heroin:Rx Opiate 32 cardiac arrest cases per month responded to by SFD in 2010** *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”

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

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10 Opioid Overdose Risk by Average Daily Dose of Prescribed Opioids Received Current average daily dose in morphine equivalents (MED) preceding event Overdose events, Persons age 18+ (N=9,940) Hazard Ratio (95% Confidence Interval) Rate per 100 person years (%) (# of person years) 0 mg MED % (16,980) 1-19 mg MED2.4 (1.0, 5.5) 0.15 % (14,263) mg MED4.1 (1.5, 11.8) 0.29 % (2,401) mg MED6.1 (1.8, 20.9) 0.44 % (910) 100+ mg MED22.1 (8.3, 58.5) 1.75 % (628)

11 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.

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

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

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

15 Washington State

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

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

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

19 Challenges o Evolution of pharmacy practice o Pharmacists can be black and white o Medicaid coverage

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

21 Questions?


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