Many students graduate with an understanding of which drugs are used in pain management, their side effects and the risks associated with long term use. While this basic information is valuable to any pharmacy student, many lose or never acquire a grasp of the more patient specific information such as what dose/duration of an opiate is appropriate for a patient given their unique condition and degree of opioid tolerance. Many are unfamiliar with the efficacy and appropriateness of SNRI’s in treating neuropathic pain. These more refined concepts equip students with the tools to recognize impractical dose titrations, make responsible adjustments to institutional formularies and answer practitioner questions about alternative therapeutic options.
Of the seven pharmacy schools active in New York State, two offer pain management elective courses to their students. Wegman’s School of Pharmacy at Saint John Fisher College offers a 2 credit graduate level course titled Pain and Palliative Care. The course catalog proposes a learning experience focused on clinical care and synergistic relations with other practitioners:
“Pain and palliative care are emerging areas of pharmacy practice. This course will provide students a detailed understanding of pain and symptom management treatments for patients with advanced illness. Students will also learn methods to communicate and provide pharmaceutical care to pain and palliative care patients, caregivers, and interdisciplinary team members.”
In the past year, Dr. Jeffrey Fudin introduced a 3 credit graduate elective at Albany College of Pharmacy and Health Sciences; appropriately titled Pain Management Pharmacotherapy. His course focuses on implementing class lectures and published literature to evaluate complex patient cases. Classes also feature guest speakers which include a variety of specialists active within the pain management arena.
Instilling within students a strong focus on the transitioning of patient care is an essential puzzle piece needed to stem the rise of opioid related deaths while ensuring adequate pain management. Many patients receive insufficient palliative care due to overly-prudent practitioners and fearful patients who shy from opioid use because of the stigma associated with opioid use. In the past several years, the news has been littered with stories of drug addicts holding up and sometimes murdering pharmacists at gunpoint in order to get their hands on the drugs they needed to ease/avoid withdrawal symptoms. In publicizing efforts to counter these crimes, a new wave of legislation and drug monitoring programs has emerged into the public eye. The Internet System for Tracking Over-Prescribing (I-STOP) Act will deploy an online controlled substance reporting system within New York State that requires prescribers and pharmacists to report certain data at the time a controlled substance is issued and when dispensed. This is a great step forward toward tracking and potentially mitigating the ongoing drug diversion.
Recently, a friend of mine told me that he was afraid of being prescribed hydrocodone to deal with the pain he would soon anticipate following a scheduled removal of his wisdom teeth. He did not want to risk becoming an addict. This degree of fear is preposterous. Stepping up efforts to control the flow of opioids could yield success in thwarting criminals and “Dr. Shoppers” but awareness of these efforts needs to be managed differently. New policies could instead be presented to healthcare practitioners in the classroom setting (i.e. a pain management course), as a continuing education activity, pain certifications, and should be encouraged by healthcare employers from every discipline. Attention to this problem may help to ensure more adequate pain management for those in need and could help to minimize potential harm incurred by unsuspecting patients who might otherwise turn to heavy NSAID and/or acetaminophen use because their fear of opioid addiction irrationally outweighs their fear (or knowledge of) GI ulceration, hepatotoxicity and/or renal failure.
Generating fanfare over these new efforts may provide shallow reassurance to a portion of the population, but it ultimately discourages patients from seeking/accepting the care that they need. By educating healthcare practitioners with more course options focused on pain/palliative care, and by keeping informed within the medical scene, perhaps we can work as a team to solve the growing drug abuse epidemic without compromising patient care.
Pharm.D. Candidate, 2013
Albany College of Pharmacy Health Sciences