Taking the pain out of pain management

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The transition from hospital to care or from hospital to home is often a dangerous time for patients who are on medications, particularly pain medications containing codeine.

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Managing these patients and the medications they take is an important aspect of their recovery and the transitional period from when they leave hospital can present challenges for many patients. In hospitals they have health professionals closely monitoring their progress and their medication compliance but once discharged this supervision is no longer available.
Pain sufferers are particularly vulnerable and I believe there is a responsibility on pharmacists to be alert for these patients and assist them to use products containing codeine appropriately and efficiently. Misuse of codeine is a very real problem and one which we must be aware of and help to combat.
I was therefore concerned by a report published in the International Journal of Pharmacy Practice which found that codeine misusers “purchased OTC codeine with virtually no pharmacist interaction, or, the sale was refused with limited discussion”.
This report was a sad and damning indictment on the pharmacy profession and clearly something needed to be done in regard to further educating pharmacists about pain management, addiction problems and mental health issues with the aim of having them better equipped to manage the health issues of patients requesting OTC products containing codeine.

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“Pain sufferers are particularly vulnerable and I believe there is a responsibility on pharmacists to be alert for these patients and assist them to use products containing codeine appropriately and efficiently.”

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At the Pharmaceutical Society of Australia we moved swiftly and have developed a range of education and practice tools to equip pharmacists to help address this issue.
In developing these tools, PSA engaged in consultation with stakeholders and members and also drew on the outcomes and conclusions from workshops and other meetings which have examined how best to approach the problem.
What became very clear was the need to do something quickly to optimise health outcomes for consumers and that, at present, there is a disconnect between pharmacists and consumers seeking pain relief. Sometimes this pain relief is severe and at times the patient is in that transitional period between hospital care and home or other care.
It also became very clear that consumers seeking pain relief want greater engagement from pharmacists; that these consumers feel stigmatised and that pharmacists generally lack empathy with these consumers.
Taking these views on board, PSA developed a range of clinical education, communication education, referral option and pharmacy workflow resources to assist pharmacists.
We will also have a wide range of practice tools to support these other initiatives.
Our research also showed there was a gap in pharmacists’ communication skills and to this end we have released a range of communication based products including motivation interviewing and collaboration modules, and are developing a video on how to initiate and engage in ‘hard’ conversations with consumers.
PSA is also working with Pain Australia, Medicare Locals and other stakeholders to develop and access existing databases of referral options.
With these resources in hand, pharmacists are in a better position to counter what the International Journal of Pharmacy Practice report highlighted as significant and damaging shortcomings.
That report, titled Opportunities and challenges: over-the-counter codeine supply from pharmacists and codeine consumer perspectives, pointed out that, “The OTC codeine-dependent participants found it generally easy to access OTC codeine, describing ‘standard’ questioning, minimal intervention from pharmacists and only occasional refusal to supply. A better appearance and presentation was generally linked to easy codeine supply.”
The report concluded: “The experiences of participants suggest a number of barriers exist to effective intervention for OTC codeine dependence in the community pharmacy setting. Identification of these barriers will provide an opportunity to more effectively target interventions to reduce harm related to OTC codeine products. Increased involvement of pharmacists in OTC codeine sales was associated with help-seeking by codeine users.”
These findings reflected very poorly not only on the practice of pharmacy, but also the perceived commitment pharmacists have to securing the best health outcomes for patients in this category.
It was not enough to simply say that such examples were isolated and were only indicative of a very small minority of the profession. While this may be true, any instance as detailed in the report is one instance too many and that is why PSA reacted swiftly and robustly in developing these tools and resources.
Grant Kardachi was elected president of the Pharmaceutical Society of Australia after service as vice president and a board member for three years. He is a community pharmacist who recently sold his business interests but is still accredited to undertake medication reviews and sits on the Australian Association of Consultant Pharmacy.