Special guest Jeffrey Bratberg, PharmD, FAPhA, Clinical Professor of Pharmacy Practice from the University of Rhode Island joins us to talk about opioid safety.
Listen in as we discuss strategies for reducing risks with opioid use, including safe opioid dosing and identifying risky med combos. And you’ll hear a review of the different opioid overdose reversal options as well as important counseling tips for all patients taking an opioid.
None of the speakers have anything to disclose.
TRC Healthcare offers CE credit for this podcast. Log in to your Pharmacist’s Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter and Prescriber Insights:
- Chart: Equianalgesic Dosing of Opioids for Pain Management
- Toolbox: Appropriate Opioid Use
- FAQ: Opioid Tapering: Tips for Success
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Transcript:
[Intro Music]
Welcome to Medication Talk, the official podcast of TRC Healthcare, home of Pharmacist’s Letter, Prescriber Insights, RxAdvanced, and the most trusted clinical resources.
On today’s episode, listen in as we discuss strategies for reducing risks with opioid use, including safe opioid dosing, and identifying risky med combos. You’ll also hear a review of the different opioid overdose reversal options and important counseling tips for all patients taking an opioid.
Our guest today is Dr. Jeffery Bratberg from the University of Rhode Island College of Pharmacy.
This podcast is an excerpt from one of TRC’s monthly live CE webinars. Each month, experts and frontline providers discuss and debate evidence-based practice recommendations.
The full webinar originally aired on April 16th, 2024.
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[Music Bed Starts]
And now, the CE Information.
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This podcast offers Continuing Education credit for pharmacists, physicians, and nurses. Please log in to your Pharmacist’s Letter or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
None of the speakers have anything to disclose.
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Now, let’s join TRC Editor, Dr. Sara Klockars, and start our discussion!
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SARA KLOCKARS:
…We all know that managing pain with opioids is one of the most challenging areas of clinical practice. The potential benefits of opioids…in achieving improvement in functioning and adequate pain relief must be weighed against the many risks. We really wanna just think twice before writing for an opioid or slowing down when filling an opioid prescription…The other thing I think we all wanna do is just considering all the options to manage pain before we start an opioid, we really wanna emphasize the importance of the non drug measures like exercise…physical therapy, acupuncture, rest and ice and then the non opioid meds for most patients, such as an NSAID for kidney stone pain or deloxetine for neuropathy. But…We all know we need to individualize care and there may be some circumstances where a patient needs an acute opioid prescription such as major surgery or a sickle cell crisis or patients may need to be on long term opioids to function daily when other measures aren’t effective or an option. So, you know patients with kidney disease who can’t take NSAIDs or in some of our patients with cancer. So today we wanna focus on those patients that may need an opioid…and see how we all play an important role in optimizing the safe use of opioids. We’re gonna focus in on safe dosing strategies, avoiding risky combos, and then overdose…reversal agents…So, Jeff to kick us off, can you briefly review some considerations when thinking of starting a patient on an opioid?
JEFFREY BRATBERG:
So I always think about opioids as, you know thinking about there’s two ways to use them right So there’s acute…conditions where opioids may be necessary and used in as, low a dose lowest effective dose and it short as possible short duration as possible But then there are people who have chronic pain syndromes and we have to think about what have they tried before Sara talked about, non drug therapies We talked about, non opioid therapies. You know have we maximized those What are limiting the patients in those ways And we layer on opioids on top of that But again we treat folks who are using opioids chronically somewhat differently than people who are using them acutely or you know less than seven days for example. So of course we also have to think about comorbidities, organ function. But I think what my goal of this talk is to say…If a patient is in pain we believe them and just like we start a medication…for any person we have the same kinds of of checklists honestly is that we say is this safe and effective for them and opioids are safe and effective therapy, and we just evaluate similar things So What is their substance use history? Have you developed a rapport with the patient I love the idea of every interaction with the patient is patient centered care What do they want? Because whether they have success or whether they have trouble…staying adherent to the opioid for one reason or another taking too much taking too little, having pain breakthrough pain we need to hear those things And patients are you know Opophobic too just to to an extent where they hear all these things about opioids they’re unwilling to do it So you need to have the confidence as a prescriber or a dispenser or anyone that interacts with the patient and their family plays a big part to say how do we get you through this acute setting Or if we’re going down a journey where you’re going to take opioids chronically, what are the best ways to keep you safe? what are the most effective doses for your particular conditions and situation, and how can we monitor you in a compassionate way…
SARA KLOCKARS:
That is an excellent overview And I think too…the other risk there is untreated pain and where that can go for patients who don’t have Great pain control in chronic pain conditions so making sure that there’s the right balance that comes back to individualizing that care Let’s go ahead and jump to safe dosing strategies. When we’re thinking about starting an opioid…What is the first thing that comes to mind to do it safely? How should you recommend starting an opioid?
JEFFREY BRATBERG:
I think if we put pain control as a function of how we treat other chronic diseases or newly diagnosed diseases to say okay What is your expectation? Our goal is not the elimination of pain Right It is a mitigation it is quality of life is how do we balance the potential limitations…or side effects of opioids with the benefits in terms of again whether it’s somebody playing with their grandchildren or playing with their children or functioning at work if they have improved sleep Those are the things that we need to talk about. Is this something that is going to be long term and having those close conversations and frequent conversations about that, or is it okay You have this pain and the severity and these other strategies aren’t working We’re gonna you try and opioid, see how it works and then work with the patient to say okay now when do you want to go off this? Very few people actually take of people who take opioids take it for a very long time or beyond ninety days as the CDC classifies chronic pain. so we have to think about sort of there’s the seven day period there’s the seven to ninety day period and then we have different conversations when we go beyond the ninety days. But even after those seven days or some say as short as three days you can have withdrawal and and that is a amazingly difficult thing to go through Again in those patient arrangements we wanna say Hey if you stop your opioid, you’ll tell your doctor about it like as a pharmacist What do we counsel our patients on? Talk to your doctor or pharmacist if you change how you’re taking this drug So if that rapport is essential, making sure the patient knows…the effects of that opioid and why they’re taking it and what to expect and don’t stop abruptly because withdrawal is going to especially if they’re unaware that that could possibly happen you’re gonna damage the relationship which is really so important to, again managing pain along with other chronic diseases…
SARA KLOCKARS:
Yes And I think we say in a lot of our articles to have an at strategy. So setting those expectations with the patients ahead of time is super helpful, letting them know if this isn’t a long term thing, the pain with this surgery usually lasts about a week setting those expectations.
JEFFREY BRATBERG:
Well again I think what I hear anecdotally…in folks and practice is that there are people who are given an opioid after a surgery. And because they’ve heard so many horrifying things about opioids, they don’t take it and they unnecessarily suffer So I think of it as more of a community or public health effort to say, you can take opioids You can do it safely You can improve your quality of life And you can stop them in these short periods of time for these moderate to severe pain syndromes like certain surgeries and things like that where yes you can take the opioid.
SARA KLOCKARS:
Yeah That’s a good point. What are some of the different types of discussions that you have with patients when you are trying to decide whether long term use is right for them?
JEFFREY BRATBERG:
Well I I think it’s the same conversation about stepping up therapy, maximizing…those non pharmacologic therapies. What kind of pain is it Often people will start to have different kinds of pain and so you mentioned Deloxetine you know is there a neuropathic component? Are we managing the conditions that are leading to the chronic pain? I think the most important thing is behavioral health Right So some folks include any kind of substance use disorder both opioid or other substances, whether legally available or not, but also mental health right Depression and pain go hand in hand and so sometimes opioids that they work on the same receptors in the brain they can have effects on depression They can…some people say it relieves their depression Some people it deepens it So I think it’s important that when folks have pain and I think it’s really hard for us to imagine what it’s like to have pain that limits our function for more than three months We really need to have those behavioral health conversations and maybe add adjunctive agents and obtain a diagnosis for depression or anxiety or those kinds of things?
SARA KLOCKARS:
Yes Treating those comorbidities is super important. Yep. So let’s move along and you mentioned earlier you know tapering off opioids…even after just a few days So how do you decide this patient’s gonna need to taper off versus I can just tell them to stop Is there like a general guideline that you use?
JEFFREY BRATBERG:
Well again so it all depends on the regimen what their experience is how naive they are to opioids how their pain is, very often people will say, I got prescribed this seven days or these three days and I only took one Well you don’t need to taper off of one or you took one day or two days. And then there are people who maybe they’re prescribed something and they’re taking there as needed as well as a chronic bed They say well I took these pills four times a day and I was told to take it for two days and stop There might be some withdrawal so making sure that folks know what withdrawal looks like and knowing that it’s okay to go from four times a day to three times a day to two times a day to one time a day That that makes sense But if they have pain, it’s okay to take more…And my favorite strategy is if it’s a seven day therapy, give them the expectation to take it three days and check-in How are you doing You know what is your function? Do you need to take more, or if you have signs of withdrawal, reach out, and let’s design a strategy and let’s give you instructions on how to do that Yeah So withdrawal symptoms is that anxiety I mean I know somebody very close to me who had a broken collarbone took opioids for four days had sweating anxiety didn’t know what was going on You’re all told you don’t have withdrawal if you take seven days And every patient’s different. And and it’s really all about when we think of tapering, explain to the patient that it’s about slowly going off the opioid…to avoid these symptoms And I think if you again are clear with the patient about what withdrawal is how to avoid it and why we’re continuing to take pills I think everyone will have a good outcome.
SARA KLOCKARS:
That’s great And then what about a general rule for patients who are on chronic opioids for years and you’re trying to you know slowly wean them down Is there a, recommended amount to reduce the dose by I know in some of our articles, we say about five to ten percent per month Just take it really slow because the goal is to get patients off of it Is there anything like that you would recommend in your practice?
JEFFREY BRATBERG:
Yeah That’s what I would say I would say in your example if it’s years of opioid use I think the most important thing is really it is not our job as clinicians, even in great relationships with patients to say now it’s time to taper You know for those great people who are on for years, They’ve lived in fears and still do in some places of actually just maintaining their opioids. The best studies that I cite are those where patients if they self initiate the taper they are much more successful in their goals which could be just a lower dose every day or could be completely going off And so I think very very importantly, there are clinicians who in the guise of doing right by their patient actually don’t do them right and do these aggressive tapers where it’s ten percent per week or it’s um-hm fifty percent per week to say okay now it’s time to go off. Those are really dangerous situations to avoid. I think we’re all not gonna do that I think again five or ten percent per month close monitoring, see how the patient is And we need to have the expectation that yeah maybe it’s fifty percent…in six months and that’s where they’re at and that’s the function they wanna be at.
SARA KLOCKARS:
Yeah Patient buy in is huge and I think something else…to consider too is giving the patient options. You know we could do it this way or we could do it this way and and once they can make that decision for themselves and that seems to help things move along as well.
JEFFREY BRATBERG:
As we talked earlier in long term chronic pain patients is that you still need to evaluate everything else that’s going on You know did this person have chronic hip pain and then had a surgery and now they don’t And…now that’s the time Is it because they just want to I think that’s great but Look what else is going on Is it they’re no longer depressed or they’ve tapered off their behavioral health medications or They’re now receiving counseling and they can have more function you know really evaluating what else is going on Still…with other agents so that the taper and the opioid doesn’t trigger I shouldn’t say trigger but so there isn’t some sort of pain crisis and then it’s back on the opioids and now their goal is not what they want and causes more problems that way.
SARA KLOCKARS:
That was a great discussion and I’m gonna move us along so we can talk about switching opioids. We actually have a question coming in about shortages. That is one indication for switching opioids, and then We often will do it for insurance reasons or changes in kidney or liver function. So is there a general…kind of guide that you use when you’re helping patients switch their opioids.
JEFFREY BRATBERG:
If there’s shortages, there’s the rare patient who’s functioning really well on a branded medication it becomes generic and it’s sort of what is the insurance requiring there, really using those Equa analgesic dosing charts to say are we switching to something that’s extended release from immediate release or vice versa Because we’re tapering and we want to have more sort of control of that Co morbidities like kidney or liver disease if it’s improving or not But it’s really going okay where are they at use those charts, what is their goal? Why are we stopping sometimes there’s a switch and they wanna switch back So again I think this is always an opportunity to think about reviewing patient goals and say okay is this time to start at a lower dose which is potentially safer, but shouldn’t always be the goal I think we want to look at what they’re taking in a total dose where are they at and then thinking about how we overlap those opioids so that we don’t have any period of time where there’s unnecessary pain.
SARA KLOCKARS:
So this is one area that these patients are at an increased risk of overdose. There is that incomplete cross tolerance between opioids that we wanna make sure everyone’s aware of So having that discussion with patients too, in a lot of our articles we do say it’s more art than science. So we definitely wanna…go through and and just be more cautious. We can always increase the dose.
JEFFREY BRATBERG:
Right. I think it’s what’s usually said is depending on the the severity of pain either initially or again how well they desire their control to be for example when we say let’s reduce the total daily dose as we switch to twenty five twenty five percent. Some people say as much as fifty percent I would stay around twenty five percent depending on how the math works out But if you’re right we can always add if they’re on a stable long acting dose and they want to switch to another long acting, you can always have breakthrough pain medications, and we can adjust up from there. I like that process.
SARA KLOCKARS:
Excellent. And just a quick plug for this chart our echo analgesic dosing of opioids for pain management resource. It does have a great dosing table and also…resources for those less straightforward meds so buprenorphine fentanyl and tramadol, some of those that aren’t as easy to switch between I think it’s super helpful.
JEFFREY BRATBERG:
I teach at a pharmacy school and this was literally an activity we did yesterday unbeknownst to me So it was great to tell the students about these charts and realize that these are there to help them both in school and in practice.
SARA KLOCKARS:
That’s awesome. So let’s transition on to…how we can work to reduce risk by avoiding risky combos with opioids so, Jeff just off the cuff What are some drug interactions that are most concerning with opioids that, you know you’re gonna like oh this raises a red flag I don’t wanna dispense these two meds Together? is there like a certain list of drugs in your head that you’re like, not doing it as being the most concerning?
JEFFREY BRATBERG:
Yeah Thank you So I think you know benzodiazepines…are most often used And I think where I see the most concerning combinations are…the use of benzos with opioids but especially in older folks And so…again what’s the worst case scenario of opioids, it’s opioid induced respiratory depression It’s overdose It’s using too much what we like to call a breathing emergency and so…I guess if I was to choose a population where I’m most concerned about is that there’s increasing amounts of co prescribed benzos and opioids some data that we see more people dying with both substances in their system And these are both prescribed, medications they both are reported in states prescription drug monitoring programs to really find out what’s going there Again we can have a whole hour discussion about tapering Benzos, which often takes…years… That’s probably more difficult in my opinion than opioids. so really figuring out why is this person on a benzo why is this person over sixty five on a drug that’s on a beers criteria list And then of course we do see increased alcohol use actually in the same population. So as we see Our population age more and we see more alcohol use We see more benzos prescribed despite guidelines recommending…not to. Again they are more difficult to come off And we do have other drugs that are used to treat anxiety or depression that have been implicated as concerning with opioids like SSRIs, but…absolutely more safer than benzos and probably more effective to treat those behavioral health issues.
SARA KLOCKARS:
That’s great. We do have those pharmacodynamic…considerations. In addition to the CNS depressants, we also have serotonin syndrome. It’s extremely rare. To see this but it can be pretty scary. And so there are some opioids with serotonergic properties. And I think you were kind of alluding to some serotonergic meds just now So what are some of those opioids that we would wanna just slow down and make sure that we’re not just…overlooking something that could be potentially harmful?
JEFFREY BRATBERG:
Well I think again we have such a wide selection of opioids that don’t have these things Again, I think fentanyl I would be less concerned about than tramadol or repairing and fentanyl comes in so many different forms that can monitor it Again this is pharmaceutical fentanyl which is extraordinarily effective and extraordinarily good for chronic pain or pain of oncology or cancer patients, tramadol is just I you know if all tramadol went away here’s my hot take I don’t think anyone would suffer. Both for this and just it is just a weak opioid…with all kinds of side effects and I see it prescribed. I’ve had family members prescribed it and it’s used and and I just don’t see really any niche for its use again for this reason or other reasons. And again I think it’s important So you know methadone for pain, again, we have I think better medications that are safer and easier to monitor, methadone for opioid use disorder, Yeah It often goes together with pain syndromes And so I think in that setting, methadone is the better choice But yeah SSRIs SNRIs you know realize these are medications…that are co prescribed for neuropathic pain. TCAs probably should avoid Again depending on what kinds of comorbidities this person has and I’m always thinking about older populations. You know it’s really doing a risk benefit and This grades having pharmacists and prescribers, all working together with the patient and their family to find the best outcome for all their disease states and all their medications.
SARA KLOCKARS:
Great overview And I think to some of these serotonergic meds are also involved with some of the cytochrome p four fifty interactions…So what we start to see and worry about is stacking of meds. Right So if you have patients that are on…multiple…drugs that are inhibitors of two d six And then there’s on a serotonergic…opioid we just start stacking all of these things and then we’re not sure which ones are causing what problems so I think it’s it’s also just important to note that…some of these opioids…do also get metabolized…via SIP two d six and three a four. So those are also good to just kind of point out and know what some of those common offenders are.
JEFFREY BRATBERG:
I’d say this is just all part of the the safest medication is the one that they don’t need and can be stopped or deprescribed but I think there’s also we have to look at sort of the the holistic view of the patient to say what diseases are we treating? These are in some cases relative contraindications and we can again monitor people’s pain We for some of the anti convulsants we can monitor through serum levels, think about how closely can we monitor these things What exactly are they there for…
SARA KLOCKARS:
Yes And then we add in all those other specific patient considerations like kidney function and liver disease and aging and respiratory concerns So some of those underlying conditions that can also impact and it just makes it very tricky. So I think that’s…a good discussion And and you know when you’re trying to figure out if a patient’s a candidate something to evaluate all of all of these things fit into that bigger picture. So on that topic we did have somebody chat in a question about is it safe to use opioids in patients with kidney disease? What’s your response to that? And are there certain opioids that are safer in patients with kidney disease?
JEFFREY BRATBERG:
Yeah Sure… it’s a very very common question And again my pharmacist brain’s always thinking what is the degree of kidney disease Is it progressive What’s happening Is this stable or not And so we always have to characterize that And just because someone has kidney disease, we have lots of guides to, adjust medications for decreased you know clearance of creatin or decreased…kidney function. So rarely will we see that things are contraindicated until we get to a higher stages of disease. And you know there are some medications that are are not cleared by the kidney or are safer to do that I believe fentanyl is one of those And so then you can kind of consider to say well let’s take the kidney disease out of the equation and choose safe and effective opioid, that isn’t going to be modified by that just to, focus on other other factors that in terms of how we choose and maintain people on opioids.
SARA KLOCKARS:
Yes And some of those do accumulate, you know the codeines the moparidines we would wanna avoid those…in patients with kidney disease as well So that’s great.
JEFFREY BRATBERG:
And I would just avoid coding and moparadine all the time It’s just a really easy thing to avoid tramadol and coedine and moparadine all the time scratch them off your list and that’ll be great.
SARA KLOCKARS:
Yep. and that applies to liver disease as well So I would put codeine and impairedine and tramadol on my do not use with liver disease list. What what’s on yours?
JEFFREY BRATBERG:
That you said the same things.
SARA KLOCKARS:
Okay…Good Okay Well, let’s go ahead and transition on to…Opioid overdose reversal agents. We have many factors that increase the risk of opioid overdoses and many of the things we just talked about patients with a history of overdose or substance use disorder, high doses when we’re switching they’re at increased risk, And then all these different medication combos, patients who have respiratory problems or liver and kidney disease So we really wanna make sure that we keep an eye on patients that fall into this category but I think the other thing that we say in several of our articles is anyone that uses an opioid may be at risk for overdose. So…we don’t necessarily need to focus on certain people We can just consider, you know somebody’s getting an opioid prescription They’re at risk. So, Jeff, Can you give us a brief overview of the available opioid overdose reversal agents…
JEFFREY BRATBERG:
Absolutely. So everybody listening here and everyone you know is a first responder to opioid overdose regardless of what opioid caused it And so that means that everyone, probably everywhere you live has access to naloxone in several different ways now. So Deloxone, which goes by different brand names. The most common way to access it is the intranasal version a four milligram version, and that is over the counter And so you can, right now, in our research only available in pharmacies and so you can find it over the counter. There are still products that are on standing orders in states and so you can always ask your pharmacist to fill it through a standing order You can ask your doctor to fill it that way where there’s in every state there’s community programs that distribute naloxone for reduced costs or free. Available in vending machines There’s those types of things There is a higher dose of naloxone, an eight milligram spray, not as effective, may lead to more withdrawal without any greater effects So we probably don’t need any higher doses. There are injectable forms again depending on where you are how comfortable the patient is you can titrate those doses the intranasal forms who can’t. And there’s a newer marketed agent called nalmefene, which again comes in injectable and a new intranasal spray. the features of nalmefene are that it lasts longer. It doesn’t last like naloxone. But again the longer that it lasts there’s no data that shows that it’s any better than naloxone. The concern is that it may extend withdrawal And as we talked earlier anyone who takes an opioid and has withdrawal and then it’s extended, may be less likely to actually seek care again in the setting of opioid overdose in opioid use disorder…
SARA KLOCKARS:
That is a great overview and I think We often just emphasize to increase access to any of these agents rather than focusing on which product to use
JEFFREY BRATBERG:
The only thing that was gonna build off of that is that it’s great to know that it’s available It’s great to know that you have it But every time that you’re around another person it’s important to have naloxone on you right in your bag, in your car. There’s many many people who have naloxone that is sitting in a kitchen drawer It is not available for you to help reverse overdose and save a life So it’s always important to really have it on you and that is also part of the way to reduce the stigma of opioid overdose or these reversal agents themselves.
SARA KLOCKARS:
And that’s what I was just gonna ask you to comment on as many people do struggle with how to bring these up to patients. So what are some tips and just kind of working it into the conversation…just like you would work in This is a side effect You’ll have constipation with opioids This is what we do to treat it How do you recommend…that our frontline folks work this discussion in to every discussion about opioids with patients.
JEFFREY BRATBERG:
Well you just said it there It’s a universal offer Right So anytime you want to reduce the intended or unintended stigma or discrimination…against folks is that you’re taking opioid I want you to be safe You’re showing your connection to the patient. I want you to have this I wanna train your family to have this and this is something that we do all the time So if the patient feels like they’re being supported and feeling safe, it shows the importance of monitoring for unintended…overuse of prescription opioids or use of you know more potent contaminated opioids that are unregulated…And there are several states that have had success like the one that I’m in where we mandate co prescribing so with every opioid, or every opioid benzodiazepine…prescription, naloxone is automatically recommended It’s automatically filled And you say here you go This is what it is And so that helps reduce the stigma among the people dispensing the people prescribing and the patients who pick up their opioids this is just something that happens all the time We wanna normalize it.
SARA KLOCKARS:
Yeah That’s great. We also had a question on age limits on these agents. Yeah So how how young can we go when giving naloxone.
JEFFREY BRATBERG:
Anyone with a nose can get naloxone, intranasally or anyone with a muscle works on all people There is no Again as we go up in dose we may not see increases and depending on how it’s administered varies But as we increase, doses, We may not see greater efficacy but we know that they’re safe right based on the products that have been approved. Even if you’re not sure if an opioid is there The great thing about narcane it’s really easy to administer. It acts really quickly, you know to call 911 I actually just did a training on CPR, and there’s a pathway for respiratory emergencies and the use of naloxone built into that. So anyone who’s trained in CPR should also be trained in naloxone. I think everybody should be trained in both So it’s all just part of like I’m a first responder. Who are you gonna respond to? most likely probably one of your family members and so just have this ready and make sure everybody knows what to do because you can’t respond…to an overdose yourself…
SARA KLOCKARS:
Great tips there. We actually have another question…Do you recommend a specific agent for opioid reversal for some of the street drugs like carfentanyl…
JEFFREY BRATBERG:
Yeah So first the one that you can get the one that you’re going to carry Right So there’s that I think the shorter you know naloxone has the longest decades long history of effectively reversing…one or two doses is how it’s packaged. effectively reverses it So there’s often media that say you know six doses were given and the thing that’s hard to parse in those stories are…were six doses needed or were six doses given And that just shows how safe it is is that people have it and they give it and that’s great. But it’s really important to think about Was it actually needed and very often it’s not We know that an average of one to two doses is effective whether it’s fentanyl, car fentanyl, those types of things The answer is carry naloxone and use it.
SARA KLOCKARS:
Exactly…Yep. Thank you. So in addition to discussing these reversal agents with patients what are some other important counseling tips that you don’t wanna miss when talking with a patient getting an opioid?
JEFFREY BRATBERG:
So you mentioned one of them is you know we we focus a lot necessarily on respiratory depression And I think the key thing is is also constipation right And so we need to even as we increase doses, we still should make sure that we’re counseling about constipation… And so we have that there using a laxative using don’t use docusate Cena or or other, stimulant agents work well. We again co prescribe or co dispense naloxone however mechanism that can do that. And it’s really anybody who has access to that You should have naloxone available and known but the opioids you can protect them too You can have proper storage Nobody except the patient really needs access to those opioids or if they have assistance to give opioids to someone, know that they can keep those out of reach and keep naloxone within reach. If you have opioids in your house There’s many many people who have opioids and antibiotics and all kinds of things and creams left over It’s best to just get rid of them.
SARA KLOCKARS:
And then regarding…disposal I know some pharmacies have definitely started handing out the med disposal packets with each opioid or risky prescription. But if we don’t have these packets what are the best ways to safely dispose of opioids…
JEFFREY BRATBERG:
Yeah I think you know so there’s you know there’s lists online that talk about what’s safe to flush, there’s the classic mix with kitty litter Again I had cats for twelve years I don’t anymore I do not have kitty litter but Maybe I buy something to dispose of my opioids but you really can just dispose of them in the trash There’s, you mentioned pharmacies you know you have medicine disposal there I think that’s important so if you can flush it flush it if you…then your pharmacy where you’re getting it filled and you wanna get rid of it there, there are drug enforcement administration or DEA take back days where they, there’s a location where you can drop off all your meds including controlled substances. So those are things And again it’s really just about reducing the risk.
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If you’re not yet a Pharmacist’s Letter or Prescriber Insights subscriber, find out more about our product offerings at trchealthcare.com.
Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. Or find the show on YouTube by searching for ‘TRC Healthcare’ or clicking the link in the show notes.
You can also reach out to provide feedback or make suggestions by emailing us at [email protected].
Thanks for listening to Medication Talk!
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