How does opioid deprescribing in primary care affect community pharmacists?
Problem
Increases in opioid prescribing in the UK have received significant attention from researchers and policy makers in recent years. Several studies and initiatives are in development, or already exist, which support opioid deprescribing in primary care. However, the impact of deprescribing on community pharmacists, who supply medicines to those patients involved, has not been considered in previous research.Community pharmacists are commonly the first healthcare professional a patient will see following a GP appointment, the last before a medicine is used, and the only one with regular contact between reviews. This research forms part of a larger study which aims to explore the current role of community pharmacists in relation to prescribed opioids, and how they could further support patients to reduce the risks of harm from these medicines.
Approach
Qualitative, semi-structured interviews with community pharmacists in a patient-facing role, recruited though professional networks. Interviews conducted via MS Teams, video-recorded and transcribed verbatim. Inductive, first-order coding followed by thematic analysis. To date, 9 interviews have been completed between March and December 2021 with recruitment ongoing.
Findings
All pharmacists reported a lack of information associated with opioid prescriptions made it difficult to identify those who may require further support. A few pharmacists had been approached by patients and carers with questions or concerns relating to deprescribing, but others had not seen or heard any evidence that deprescribing was happening in their local area. Where attempts to reduce opioids had been seen, pharmacists generally described these as unsuccessful, associated with vague prescription directions to reduce the dose, and that patients were resistant to the changes made. Conversations with patients about reducing opioid use where there was limited pain relief had occurred as part of the MUR service, but these had reduced since it had been decommissioned. There were some examples from pharmacists who had proactively engaged with patients about their opioid use during prescription counselling, encouraging them to speak with their GP about reducing the dose where appropriate.Most of the pharmacists interviewed stated they would be happy to support patients as their opioids were reduced if the necessary systems were in place to facilitate this.
Consequences
Opioid deprescribing is a complex issue involving several stakeholders, including community pharmacists. Involvement in deprescribing varied between participants in this study, however all community pharmacists cited they currently had insufficient patient information to expand their clinical role in this area, and most were positive about additional opportunities to support patients. Recommendations and programmes for reducing opioid prescribing should consider the contribution of community pharmacists.