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Pharmacists' role in reducing opioid misuse highlighted at 'STLCOP Talks'

There’s no magic bullet to solve the opioid crisis, but there are steps pharmacists can take to address it, St. Louis College of Pharmacy professor Amy Tiemeier said Wednesday evening.

Tiemeier was one of three St. Louis College of Pharmacy professors who presented their medication-related research at the Country Club of Missouri. The presentations were part of the inaugural “STLCOP Talks” that showcase research to alumni, prospective students and health care professionals. STLCOP Talks are based upon the popular TED Talks, where speakers present a topic in a short span of time.

“When we are giving people medication that is supposed to help, and it’s leading to deaths, we need to address that,” Tiemeier said at the start of her 12-minute presentation about the pharmacist’s role in the opioid crisis.

There are four ways to address the crisis: prevention, treatment, harm reduction and recovery. Properly disposing of medications is the “simplest, easiest way” to prevent medications from being abused or falling in the wrong hands, Tiemeier said.

Drug takeback efforts in Missouri have increased in recent years, and since September 2010, Missouri has collected more than 370,000 pounds of pills through drug takebacks. This number is higher than what surrounding states have collected, in part because Missouri has raised awareness about the importance of proper drug disposal, Tiemeier said. She said Columbia has also done its part: 973 pounds of medication were collected in October during a takeback day.

Tiemeier also highlighted a bill working its way through the state legislature that could bring drug disposal kiosks to local pharmacies across the state.

Pharmacists also need to be cognizant of the importance of having naloxone, also known as Narcan, in stock at pharmacies, Tiemeier said. Naloxone is an antidote that can reverse the effects of an opioid overdose. A standing order signed into effect in August allows Missouri pharmacists to dispense or sell naloxone to anyone who is at risk of an overdose or at risk of witnessing an overdose. Pharmacists are required to give naloxone education when they dispense the antidote.

But an August survey showed that 45 percent of pharmacies surveyed did not have naloxone in stock, Tiemeier said.

Prescription drug monitoring programs also are a key way to limit opioid abuse, she said. Missouri does not currently have a state-wide program, but St. Louis has allowed other counties to enter into its prescription drug monitoring program. It now covers 75 percent of the state’s population and over 90 percent of providers, she said.

Melanie VanDyke presented research about medication-saving behaviors, some of which overlaps with opioid abuse. In a collaborative study with University of Missouri-St. Louis, her research team looked at the relationship between medication-saving behavior and hoarding, VanDyke said. The study looked at women who help family members who take medication, whether through reminders or driving them to the pharmacy.

VanDyke said there were no standard measures for medication hoarding, so her team worked to develop a valid and reliable assessment. The women in the study were asked questions such as how many medications their family members took and whether the women had ever saved medications. The researchers were able to create a scale with good reliability, although the research team found medication-saving behaviors were not related to the overall number of prescriptions the women handled.

Medication hoarding can have several negative effects, VanDyke said. Some people who hoard their medication do not take it as directed, and some people save expired medications.

“This is why it’s important that we have medication takeback efforts, which dovetails with the opioid crisis,” VanDyke said.

Ryan Moenster presented his research about outpatient parenteral antibiotic therapy (OPAT). The therapy involves patients being able to complete intravenous antibiotic therapy at home or in an out-patient setting. This allows patients to avoid remaining in the hospital for a long time. It also decreases hospitalization costs.

Working with patients at the VA St. Louis Health Care System, Moenster and his team conducted three studies on how to optimize OPAT while minimizing adverse effects. For example, in one study, Moenster noticed an increasing number of patients were experiencing adverse effects while on Ceftaroline. After looking through patient records and forming a comprehensive list of who had received the antibiotic, Moenster’s team found 13 out of 75 patients had adverse reactions.

Moenster said he believes pharmacists can play a large role in OPAT, and that “5 percent of the job is being a social worker.”

About 25 people attended Wednesday’s event, including alumni, prospective students and St. Louis College of Pharmacy staff. St. Louis College of Pharmacy President John Pieper said that other STLCOP Talk events were being planned throughout Missouri, Illinois and Indiana.

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