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The Washington State Pharmacist Perspective. Jenny Arnold, PharmD , BCPS Director of Pharmacy Practice Development Washington State Pharmacy Association. Objectives. Describe Washington State’s Opiate Deaths Discuss the Scope of Practice of Pharmacy

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the washington state pharmacist perspective

The Washington State Pharmacist Perspective

Jenny Arnold, PharmD, BCPS

Director of Pharmacy Practice Development

Washington State Pharmacy Association

  • Describe Washington State’s Opiate Deaths
  • Discuss the Scope of Practice of Pharmacy
  • Explain Collaborative Practice Agreements
  • Analyze the challenges of initiating a CPA
  • Examine alternatives for pharmacy involvement

Opioid Sales in WA State, Estimated # daily doses sold annually

Methadone does not include methadone dispensed by narcotic treatment programs. Methadone data provided by DEA for 2007-2010 included narcotic treatment programs, estimates removing expected NTP use are shown with a dashed line

Source: Drug Enforcement Administration Automation of Reports and Consolidated Orders System, data include medications prescribed and dispensed.

Data provided to and analyzed by Caleb Banta-Green Alcohol & Drug Abuse Institute, University of Washington

Defined Daily Dose utilized from WHO


Outpatient, Inpatient, MMT,

  • At the population level rx opiate abuse appears to precede heroin abuse
  • King county data show that 40% of heroin users were “hooked on” Rx opiates first
unintentional prescription opioid involved overdose deaths washington 1995 2008
Unintentional prescription opioid involved overdose deaths Washington 1995-2008

Surpassed traffic fatalities

Source: Washington State Department of Health, Death Certificates, Jennifer Sabel, PhD

medic one responses
Medic One Responses

32 cardiac arrest cases per month responded to by SFD in 2010**

45 serious opiate overdoses per month responded to by SFD in 2011*

  • Approximately 1:1 Heroin:Rx Opiate

*268 serious opiate overdoses per our chart abstraction for 6 months in 2011

** “384 out of hospital cardiac arrest cases treated by SFD in 2010”

  • Doctor of Pharmacy Degree is now the minimum degree to enter practice.
  • This entails normally 7 years minimum of education
  • Pharmacists are the medication experts in healthcare
  • Post graduate training opportunities include residencies and fellowships.
pharmacists as mid level prescribers
Pharmacists as Mid-level Prescribers
  • Dependent prescribing
  • Collaborative Prescriptive Agreements
  • Similar to PA’s
  • The laws vary in in each state.
collaborative prescriptive agreements
Collaborative Prescriptive Agreements
  • A legal agreement between a prescriber and pharmacist
  • Agreement must list:
    • Where and who
    • Which drugs or diseases
    • Policies and procedures
    • Liability insurance
  • RI Pharmacy Laws Section 25.0
pharmacist participating in cpa in ri
Pharmacist Participating in CPA in RI
  • A pharmacist participating in CPA must
    • Have post graduate training/experience
    • Access to patient information
    • 5 hours of CE in the area each year
washington model
Washington Model
  • Public Health- Seattle & King County began distributing in February in 2012
    • Recruitment via needle exchange
    • OD prevention and intervention training at Needle Exchange
    • Narcan prescribing and dispensing by Public Health pharmacist
    • CPA facilitates this
  • Police training video recently released based on survey findings
expanded washington model
Expanded Washington Model
  • Partnering with Community Pharmacies
  • Target those either at risk of having, or witnessing an overdose
  • Utilizing web based patient education and other handouts to limit impact on pharmacist time
opportunities to engage pharmacists
Opportunities to engage pharmacists
  • Show the pharmacists what their practices will look like if they prescribe and dispense naloxone
    • Screening forms
    • Example CPA
    • Physician Partners to sign CPAs and refer patients
  • Education – make the pharmacists the experts in naloxone
  • Resources and references for questions and further education
  • Students
    • Teach this material in schools, so that students come out expecting to do this
    • Partner with faculty members to include in curriculum
  • Evolution of pharmacy practice
  • Pharmacists can be black and white
  • Medicaid coverage
other ways pharmacy can help
Other ways pharmacy can help
  • Stock Naloxone injections or kits
    • Cash payment
  • Overdose education, especially to patients on more than 100 morphine equivalents daily
  • Other Public Health Opportunities
    • Immunizations
    • Emergency Response