Category: Federal Forum Posters
Purpose: At Veterans Affairs (VA) Nebraska-Western Iowa Health Care System (NWIHCS), rates of opioid prescribing have decreased approximately 42 percent from 2012 to 2017. Pharmacy clinics within NWIHCS are more involved in the opioid tapering process, and clinical pharmacists now play critical roles in opioid tapers. Electronic and pharmacy medication therapy management (MTM) consults are placed to clinical pharmacists to aid in opioid tapers. The purpose of this study was to assess pharmacists’ roles in opioid tapers by determining the percent morphine equivalent daily dose (MEDD) reduced and percentage of veterans successfully opioid-free at the end of the data analysis timeframe.
Methods: The institutional review board approved this study. Veterans referred to clinical pharmacists for opioid tapers from July 1st, 2017 through October 31st, 2017 were included for data analysis. Veterans were followed through July 1st, 2018. Electronic and MTM consults for clinical pharmacists were used to collect a list of veterans referred for opioid tapers. For MTM consults, veterans met in person with a pharmacist to discuss their taper. With electronic consults, pharmacists formulated the taper and sent it to the requesting provider. Veteran’s opioid use was tracked using the VA computerized patient record system. Veterans followed by non-VA providers and received their medications outside of the VA were excluded due to a lack of sufficient data to track opioid use. Through retrospective chart review, data were collected on initial and final MEDD, medication tapered, initial and final pain scores, adjuvant pain medications added or increased in dose, successful tapers, and time to taper off opioid. Descriptive statistics were used to find the percentage of veterans opioid-free by July 1st 2018, average percent reduction in MEDD, average percent change in pain score before and after the taper, percent of veterans requiring adjuvant pain medications, and average time to taper off opioid.
Results: Out of the 87 total consults sent to clinical pharmacist regarding veterans on opioids, 46 involved opioid tapers and were included in this study. The number of visits with clinical pharmacists ranged from one visit, which included just the taper recommendation to the provider, to up to nine total visits with the clinical pharmacist. Out of all the veterans included, 32 veterans had only one visit with the clinical pharmacist. The most common opioid that was deprescribed was hydrocodone with acetaminophen. The average baseline MEDD was 77.34 mg per day and the average final MEDD was 15.60 mg per day. The average MEDD reduced was 61.52 mg per day and the average percent reduction in MEDD was 86 percent. The average baseline pain score was 4.86, while the average final pain score was 2.63. Out of the 46 veterans included in the study, 29 veterans had adjuvant pain medications added to their regimen or adjusted the dose of current adjuvant pain medications to aid in their opioid taper. The most common pain adjuvant added was acetaminophen. By the end of the data analysis timeframe, 76.1 percent of veterans included in the study were completely tapered off opioids.
Conclusion: The opioid epidemic has become a major topic within the VA Healthcare System. Our data shows that most veterans can completely taper off their opioids within a years’ time. This retrospective study showed that a reduction in MEDD did not lead to an increase in average pain score. In fact, through the implementation of adjuvant pain medications, veterans overall reported an improvement in pain scores. Our study showed that clinical pharmacists are valuable in guiding effective opioid tapers as well as providing pain adjuvant alternatives for veterans within the interdisciplinary team.
Sarah Albanese– Student, University of Rhode Island, Lincoln, RI