Counseling Patients with New Opioid Prescriptions

By Loren Bonner, MA, Senior Editor

When patients present with a prescription for an opioid, counseling must be a top priority for pharmacists. Since many patients may not know which questions to ask, or may be reluctant to ask questions, where is a good place to start?

FDA’s guide on what consumers should ask about new opioid prescriptions offers sample questions and ways to get the conversation started. “The FDA question guide is an important first step in engaging the patient with pain as a vital part of the care planning process,” said Chris Herndon, PharmD, associate professor at Southern Illinois University Edwardsville School of Pharmacy. “Each of these questions opens an opportunity for discussion on the safe use, storage, and disposal of opioids.” The questions include:

Why do I need this medication—is it right for me?

According to FDA, the conversation could begin: “What medication are you giving me? If it’s an opioid, are there non-opioid options that could help with pain relief while I recover?”

If pain is best managed with a prescription opioid, then:

How long should I take this medication?

FDA said patients should find out when and how to stop using, or taper off, opioids. Follow-up questions can include:

Is this the lowest dose and the smallest quantity I may need?
How can I reduce the risk of potential side effects from this medication?
What if I have a history of addiction?
What about the other medications I’m taking?
How should I store my opioid medicine?
What should I do with unused opioid medicine?
Can I share this medication with someone else?

A recent Washington Post/Kaiser Family Foundation survey, which found that one-third of long-term users said they’re hooked on prescription opioids, offers additional counseling pointers: keep medications in a safe place so they are not misused by others, and avoid alcohol or certain medications while taking opioids.

Can I have a prescription for naloxone?

Patients receiving a new prescription for an opioid medicine should discuss whether they should receive a prescription for naloxone, an antidote for opioid overdose. Patients should be aware of naloxone and how it can be obtained, said FDA.

Initiating the conversation

According to Herndon, pharmacists are taking an increasingly important role in the education and safe use of opioid prescriptions. “They have the expertise to speak candidly with patients about the benefits and harms of these agents, as well as the long-term effects these medications may have on their pain. Whether pharmacists are providing the answers to these questions initially, or reiterating themes discussed between the patient and the prescriber, when patients are better educated about their health, everybody wins,” he said.

In all cases where any opioid prescription is being presented to a pharmacist, the situation needs to be handled with more care, according to Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP, president and director of scientific and clinical affairs, Remitigate LLC, and clinical pharmacy specialist in pain management, Stratton VA Medical Center, Albany, NY. Pharmacists need to be prepared to know what to say if the patient doesn’t know what questions to ask.

“Patients need to be counseled every single time,” said Fudin.

Pharmacists also have the right to refuse a prescription if there are any red flags, according to Fudin.

“Pharmacists are part of the team and for the most part physicians are cooperative if the pharmacist calls them up with concerns about an opioid prescription,” he said.

Although laws vary by state, most pharmacists have some way to initiate prescriptions for naloxone. Organizations including the American Medical Association, among others, recommend dual prescribing for naloxone in patients who are at risk for an overdose.

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Loren Bonner, MA, Senior Editor

Column coordinators: Wm. Ray Bullman, Executive Vice President; and Deborah E. Davidson, Membership Director, NCPIE, Rockville, MD

The National Council on Patient Information and Education (now the BeMedWise Program at NeedyMeds) address critical medicine safe use issues such as adherence improvement, prescription drug abuse prevention, and quality improvements in care provider–patient communication. Visit us at www.bemedwise.org.