In January 2019, Associate Professor Keri Hager and colleagues from the College of Pharmacy, Duluth reached out to health care and social service partners to determine the needs of the community. Substance abuse disorders and mental health issues rose to the top and an affiliation with the Center for Alcohol & Drug Treatment (CADT) in Duluth was born.
A strong advocate for the role of the pharmacist in the health care team, Hager saw an opportunity for a pharmacist to make an impact in providing each client with compassionate care. Following a formalized affiliation agreement in June, Hager began offering clinical pharmacy services within the CADT’s residential treatment homes and Opioid Treatment Program (OTP), also known as a methadone clinic.
Opioids are a broad category of drugs including heroin, morphine and other narcotic painkillers. The State of Minnesota has determined that St. Louis and Carlton counties have some of the highest rates of opioid use disorders and complications.
“Through our conversations with community partners, we identified key needs for patients undergoing opioid treatment including education, patient care needs related to medication management, and some potential quality issues related to fragmented care such as non-interoperable electronic health record systems across treatment and biomedical services,” said Hager. “From this assessment, we determined a need to develop and implement comprehensive medication management services directly for patients on site at the residential and opioid treatment programs.”
This new model of pharmacy practice—offering comprehensive medication management (CMM) services within an opioid treatment program—is the first-of-its-kind according to a literature review. Hager currently meets with clients in the OTP outpatient treatment and residential programs.
“What’s unique is we are bringing the CMM services to the treatment environment and serving as a bridge between treatment, primary care, and psychiatry,” said Hager. “This is collaborative work with the interprofessional medical and social care teams.”
In the one-on-one CMM visits with clients, Hager reviews all of their medications, provides practical help and advice on navigating the healthcare system, and offers information to help clients make informed decisions on their treatment.
“All clients deserve to be treated with respect, understanding and compassion,” said Hager. “They are so appreciative of the help and the communication we provide, often in a situation of multiple prescribers for medications, and a need to bridge an information gap between the client, treatment program staff, pharmacist, psychiatrist and primary care physician.”
As prescribed medication use such as methadone or buprenorphine are often used to meet the needs of clients undergoing treatment for opioid use disorder, CMM plays a vital role in ensuring a safe and humane withdrawal process from illicit opioid use while minimizing drug-related morbidity and mortality. The CADT’s ClearPath Clinic is one such treatment and recovery program and the first nonprofit in Minnesota to operate a recovery-oriented system of care that embraces medically-assisted treatment options in a collaborative model.
“We have an important role to play as pharmacists to ensure that clients on methadone and other medications to treat their substance use disorder have the information and monitoring they need to safely use their prescribed medications,” said Hager. The clients she sees at CADT are frequently taking eight or more prescription or over-the-counter medications.
Education and research are also key components of the partnership. Hager has created educational materials for staff to use in community outreach, trained other professionals on CMM and medication-assisted treatment, and worked on outreach to caregivers in alternative settings such as corrections and the judicial system to help increase understanding of opioid use disorder.
“After working with patients in recovery, it’s clear we need health care finance reform, education to reduce stigma, and better treatments for pain, addiction and trauma—all while being mindful of social determinants of health,” said Hager.
Another priority is collecting data to evaluate the effect of CMM on care and service for clients undergoing opioid treatment. In collaboration with Duluth Family Medicine Residency Program, Hager will evaluate how having a pharmacist on the care team for CADT clients may also improve treatment retention and assist with transitions of care with primary care provider teams.
“One key message I have learned through this work is that we as health care providers need to destigmatize addiction,” said Hager. “If we treat these individuals holistically and use evidence-based practice, we will reduce opioid misuse, overdose death, crime, infectious disease, help more children stay with their parents and save money.”