Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology

Suzanne Nielsen; Freya Horn; Rebecca McDonald; Desiree Eide; Alexander Y Walley; Ingrid Binswanger; Aili V Langford; Pallavi Prathivadi; Pene Wood; Thomas Clausen; Louisa Picco

doi:10.1016/j.sapharm.2024.09.001

Development of pharmacy-based best practices to support safer use and management of prescription opioids based on an e-Delphi methodology

Res Social Adm Pharm. 2024 Sep 3:S1551-7411(24)00349-8. doi: 10.1016/j.sapharm.2024.09.001. Online ahead of print.

Authors

Affiliations

¹ Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia. Electronic address: suzanne.nielsen@monash.edu.
² Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia.
³ Norwegian Centre for Addiction Research (SERAF), University of Oslo, Oslo PO Box 1130, Blindern, 0315, Oslo, Norway.
⁴ Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.
⁵ Institute of Health Research, Kaiser Permanente Colorado, 16601 East Centretech Parkway, Aurora, 80011, USA; Colorado Permanente Medical Group, 1375 E 20(th) Ave, Denver, CO, 80218, USA; University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA; Kaiser Permanente School of Medicine, 98 S Los Robles Ave, Pasadena, CA, 91101, USA.
⁶ Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 407 Royal Parade, Parkville, Australia; Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, 64 Mallett Street, Camperdown, New South Wales, Australia.
⁷ Equity, Primary Care, Implementation and Community (EPIC) Research Unit, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Victoria, Australia.

PMID: 39289100
DOI: 10.1016/j.sapharm.2024.09.001

Abstract

Background: Opioid utilization and related harm have increased in recent decades, notably in Australia, the United States, Canada, and some European countries. For people who are prescribed opioids, pharmacies offer an accessible, regular point-of-contact, providing a unique opportunity to address opioid prescription drugs risks.

Objective: This project aimed to develop consensus-based, best practice statements for improving the safer use of prescription opioids through community pharmacy settings.

Methods: The e-Delphi technique is used to obtain consensus from experts about issues where conclusive evidence is lacking, using multiple rounds of online participation. The investigator group identified an international group of potential participants with relevant expertise who were invited to the study, and asked to identify other experts for invitation. The e-Delphi process comprised three online rounds, involving (1) statement idea generation, (2) developing statement consensus, and (3) confirming and ranking statements.

Results: A diverse group of 42 experts (76 % female, 6 countries) participated, comprising pharmacists (n = 24, 57 %), medical doctors of differing specialties (n = 12, 29 %), and/or researchers (n = 28, 67 %), with a mean of 15 years' professional experience (SD = 8.08). Eighty-five statements were initially developed in Round 1, and 78 were supported with amendments, with suggestions to merge and remove items in Round 2, resulting in 72 final statements which were all endorsed in Round 3. Items spanned seven themes: education, monitoring outcomes and risk, deprescribing and pain management, overdose education and naloxone, opioid agonist treatment, staff education, and overarching practices. Preferred terminology was determined in Round 2 and confirmed in Round 3.

Conclusions: Community pharmacies offer a unique opportunity to support the safer use of prescription opioids. These 72 best practice statements provide practical guidance on specific practices that pharmacists can undertake to support patients' safer use of prescription opioids and prevent or reduce harms from prescribed opioid use.

Keywords: Analgesics; Naloxone; Opioid; Overdose; Pharmacies; Prescription drugs; Qualitative; e-Delphi.