SAFER-OPIOIDS: A structured approach to identifying key information and drug therapy problems in chronic noncancer pain patients using opioid therapy

Clinical pharmacists from the University Health Network (UHN) and the Centre for Addiction and Mental Health (CAMH) work collaboratively in an ambulatory program to provide detailed medication assessments focused on opioid ther- apy. They found that, when contacted for infor- mation, pharmacists in the community often reported that they were concerned about their patients' opioid therapy; however, they felt that they did not have enough information about the indication or treatment plan to complete an assessment. These subjective reports are consis- tent with survey results from 2011 about Ontario pharmacists' experiences dispensing opioids; of 642 respondents, most (86%) reported that they were concerned about the prescription opioid use of several or many of their patients.4 Respondents from this survey felt that physicians often failed to recognize that pharmacists can help with opioid management; 56% reported that physicians were unwilling to communicate their therapeutic plans to the pharmacists; and 61% reported that physi- cians sometimes or frequently did not respond to their concerns.4 Prior to the initiation of opioid therapy, evidence related to the effectiveness for CNCP should be considered.1 Opioids have shown only small to moderate benefits in relieving nociceptive and neuropathic pain and improving function.9 For neuropathic pain, they are considered second-line to alternative therapies, including antidepressants and anticonvulsants, in available guidelines.10 Opioids are not indicated for migraine or tension headaches or for patients with irritable bowel syn- drome.11 Only one opioid, tramadol, has shown benefit in fibromyalgia and the effects were small; other pain-relief options should be tried.1 Phar- macists need to gather information about the indication for opioid therapy for assessment and monitoring. The indication for opioid therapy can be discussed with the patient. Clarification of the indication with the physician is also an opportu- nity to initiate a collaborative approach prior to a patient starting a trial of opioid therapy. The SAFER-OPIOIDS mnemonic provides a structured tool for pharmacists to assess and monitor opioid therapy in CNCP patients. It could also be useful as a teaching tool for phar- macy students and new pharmacists to eas- ily recall key information from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.1 The Opioid Manager is an existing point-of-care tool for provid