In the midst of the ongoing opioid crisis, which is particularly pernicious in rural areas, a burgeoning program in the Pittsburgh area—called the screening, brief intervention and referral to treatment (SBIRT) program—trains pharmacists how to spot and intervene in suspected cases of opioid addition or abuse.
According to Jan Pringle, PhD, professor, founder and director of the Program Evaluation Research Unit, University of Pittsburgh, the SBIRT initiative was trialed in a Pittsburgh-area hospital emergency department, and “SBIRT reduced downstream healthcare costs and readmissions,” she said. “Screening,” Pringle added, “in and of itself appears to be an intervention.” Pringle co-presented the Insight Session, titled “Community Pharmacy Intervention in the Opioid Crisis,” during the NACDS TSE in Denver on August 27.
The SBIRT program features short screening questions posed to customers in pharmacies, and an iPad application facilitates ease of use by healthcare practitioners onsite. “We teach pharmacists how to speak to the patients so they don’t feel shy or they don’t feel this it is not their job to do this. You [pharmacists] are well trusted healthcare professionals, and the patients sees this as really important messaging.”
The brief intervention, says Pringle, is a short conversation with patients that motivates them to change their behavior. The goal, she said, is to have commitment with the patient about how they are going to change their actions. The intervention, Pringle added, is very versatile. “You can use it with diabetes, adherence, and alcohol and drug use.” Pringle said the SBIRT motivational interviewing principles can be taught in about an hour and a half, while the more in-depth motivational interview counseling regimen requires about 24 hours of training to complete.
Once a pharmacist identifies a patient who is a candidate for intervention and possible referral, a care manager who is part of the Project Lifeline pilot program in Pennsylvania will come to the pharmacy to do a “warm handoff.” Pringle said this is a logical aspect of the SBIRT program, drawing a comparison to a medical emergency. “If this were someone who had a blood pressure of 236 over 125,” she quipped, “as a pharmacist, wouldn’t you call an EMT?”
The NACDS Foundation supports the SBIRT program, according to Pringle, and pharmacists provide vaccinations for patients using opioids against hepatitis B, screenings for hepatitis C, and referrals for HIV. In Pennsylvania, she noted, pharmacists can distribute naloxone without a prescription.
To date, the SBIRT program has screened 6,400 patients with close to 1,300 brief interventions, and 128 cases have been connected to care management. “I think a lot of managed care organizations are seeing tremendous costs associated with the opioid-use disorder public health crisis,” said Pringle.
“I believe that we have reason to believe that pharmacists are going to be extremely instrumental in addressing the opioid health crisis,” she said, adding “Pharmacy is absolutely in the queue to step up and provide a solution. I am 100% sure that it can be implemented in any pharmacy with appropriate limitation.”
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