By Tiana Tilli
It’s an all-too common story. Logan had surgery to fix their broken wrist and was sent home on tramadol. The drug is causing terrible constipation, but they feel worse when they try to stop cold turkey. Shaninder is admitted to hospital with low back pain, and isn’t responding to oxycodone anymore even though the dosage has been raised. Tarana has been hospitalized with confusion. As she ages, her body becomes more sensitive to the hydromorphone she takes for her osteoarthritis.
These patients aren’t real, but their stories of prescription opioid use are. As a pharmacist at the Pharmacists Clinic at the University of British Columbia Faculty of Pharmaceutical Sciences, I help people like Logan, Shaninder and Tarana to manage their pain as they move from hospital to home.
Tramadol, oxycodone and hydromorphone are all opioids. These medications are mainly taken for a few days or weeks to treat short-term pain, as they aren’t intended for long-term use.
Opioids act on the pain centre in the brain to give relief, but they also act throughout the body, which can lead to side effects. These can include sleepiness, euphoria, constipation, dry mouth, vomiting, and breathing difficulties. The key with prescription opioids is to use the right amount of the right drug for just long enough to do the job, and then replace the opioid with different medication(s)—or add a second medication for pain, so that less opioid is needed.
Fortunately for the millions of individuals in Canada living with pain, many organizations across the country have created programs to help manage that pain while lowering possible harms of opioid medications. One such initiative is a hospital-based pharmacist-led opioid-stewardship program at two health authorities in the Lower Mainland. The opioid stewardship pharmacists work with patients and their health care team to come up with tailored pain management plans while they’re in hospital.
Pain management plans can be quite complicated; medications need time to get to a dose that works, and medication needs can change as people move from hospital to home. Returning home from hospital means putting people in a different environment: they might have higher pain from being more physically active; or be more bothered by side effects like drowsiness as they return to work or school; or be unable to afford or refill prescriptions.
To address these issues, the hospital-based opioid stewardship program partners with the UBC Pharmacists Clinic. Our role is to help people taking prescription opioids with ongoing support once they leave the hospital. Pharmacists provide one-on-one medication management services to eligible, interested individuals in need of extra time and help. This gives people access to care and information on pain management options, without the stigma that can occur with the use of opioids. It’s free at point of service, and—thanks to phone or online appointments—we can help people across the province navigate their pain medications at home.
People who have benefited from this service are pleased. “You helped me with getting off the hydromorphone. When I was on the hydromorphone, I couldn’t really think clearly,” shared Eileen, who received care through this new collaboration.
At each appointment, I check in on how the individual’s pain management plan is working for them now that they are home. I help with any questions or problems that come up, as well as make ongoing recommendations to their doctor or nurse practitioner to adjust medication doses or try different medications as needed.
The opioid stewardship pharmacists in hospitals have also found the collaboration to be rewarding.“The partnership with the UBC Pharmacists Clinic has really helped us support the health and safety of some of the most vulnerable people we see even after they leave the hospital,” said Dr. Kseniya Chernushkin, a pharmacist at Royal Columbian Hospital.
In recent months, the BC Ministry of Health has announced an increase in the services pharmacists can offer to British Columbians, including prescribing medication for minor ailments and contraception, and administering a variety of medications by injection. More pharmacist-led services and expanded scope of practice are on the horizon and we look forward to giving individuals in BC better access to care.
Specific to opioids, the pharmacists in the pain management partnership will continue working together to help people feel supported in their pain management care while in hospital and when they go home.
While this article discusses patients referred through the opioid stewardship program, interested British Columbians can self-refer to the Pharmacists Clinic for assistance with pain management or other medication-related needs. Please call the clinic (604-827-2584) or book online to schedule an appointment. Appointments are available in-person, via telephone, or via secure video conference.
Tiana Tilli, clinical pharmacist at the Pharmacists Clinic, wrote this article with help from Timothy Lim (clinical pharmacist at the Pharmacists Clinic); Kseniya Chernushkin (Royal Columbian Hospital), Arielle Beauchesne (St. Paul’s Hospital), and Karen Ng (Surrey Memorial Hospital) who are opioid stewardship pharmacists; and Barbara Gobis (pharmacist and director of the Pharmacists Clinic).