Psychiatric pharmacists are playing a crucial role in optimizing medications for opioid use disorder (MOUD), focusing on expanding access to therapies and enhancing patient care. In a recent discussion with Pharmacy Times, clinical pharmacy practitioners Ashley Maister, PharmD, BCCP, from the US Department of Veterans Affairs, and Aaron Salwan, PharmD, MPH, BCCP, from Montefiore Nyack, highlighted their innovative approaches and collaborative efforts in this vital area of mental health.
Their conversation centered around the importance of independent practice and collaborative care in addressing opioid use disorders. Both practitioners emphasized the need to make long-acting injectable therapies more accessible. These therapies, while effective, require careful handling under risk evaluation and mitigation strategies (REMS) to ensure proper dosing and administration.
Innovative Treatment Protocols and Strategies
Maister detailed how their facility has implemented a microinduction protocol for buprenorphine, allowing patients who may still be using opioids to start treatment more easily. “We want to ensure that there are multiple options available for patients to start, restart, continue, de-escalate, or escalate their treatment,” she stated. This flexibility is crucial, particularly as many patients present with multiple substance use issues.
Salwan outlined his role as a consultant in complex cases, remarking on the necessity of having a robust network to turn to for support. “We just pick up the phone and call anyone if we have a question, and that’s been really helpful,” he noted. The collaboration among psychiatric pharmacists has proven vital in enhancing the effectiveness of interventions and improving institutional productivity.
In addition to medication management, both practitioners are committed to addressing withdrawal from various substances. Maister mentioned the effective use of phenobarbital in safely and comfortably managing benzodiazepine withdrawal, leading to more positive patient experiences compared to traditional treatments.
Reducing Stigma and Enhancing Education
A significant aspect of their work involves reducing the stigma associated with substance use disorders. Salwan believes that exposure and interaction are key to making a difference. He actively engages pharmacy students and residents in patient interactions, modeling empathy and understanding. “I want patients to feel heard,” he emphasized, explaining how he uses motivational interviewing techniques to ensure that patients are able to express their experiences fully.
Maister added that education is crucial beyond patient care. She highlighted challenges in the healthcare system, such as the legal status of harm reduction tools like test strips for drug use. In some states, these tools are considered illegal, complicating efforts to provide comprehensive care. “We shine in educating people and helping them understand why these tools are important,” she explained, advocating for interdisciplinary collaboration to enhance treatment options.
Their insights reveal a committed effort to not only improve treatment outcomes for opioid use disorder but also to reshape the overall perception of substance use disorders within healthcare settings. As the landscape of addiction treatment evolves, the critical contributions of psychiatric pharmacists like Maister and Salwan will likely play an increasingly important role in enhancing patient care and reducing stigma surrounding these complex issues.
