As a final-year student pharmacist, I have had the opportunity to appreciate different sides of practice that I knew very little about prior to beginning rotations in May. Each of my rotation experiences has provided me with unique opportunities for personal and professional growth, but none of these was more unique than the APhA Experiential Program. Among the many exciting opportunities I had as an APhA Experiential student with the Student and New Practitioner Development Department, I had the distinct honor of attending sessions during the September APhA Board of Trustees meeting.
One of these sessions gave state
association executives and national leaders an opportunity to discuss issues relevant to their particular states and practices. This was an incredible chance for me to learn about other states’ advancements in patient care and the barriers commonly encountered by pharmacists nationwide.
Controlled substance epidemic
An overarching theme that I heard echoed from executives around the room was the issue of controlled substance abuse and misuse, and the role of reversal. According to the National Institute on Drug Abuse, 52 million people in the United States, over the age of 12, have used prescription medications non-medically in their lifetime. No pharmacist, no matter the practice setting, is immune to this enormous problem.
Pharmaceutical companies, pharmacists, and government agencies alike are collaborating in hopes of producing a solution. Key measures could include the electronic transmission of controlled prescriptions, the use of prescription drug monitoring programs to integrate comprehensive prescription monitoring between practitioner and pharmacist, and the placement of a greater emphasis on mental health and wellness during substance abuse
treatment.
CDC recently announced its plans to release guidelines for the prescribing of opioids, a move that speaks to the extent of the problem nationwide. According to CDC, despite these advances, many wonder if the crack down on prescription medication abuse will result in an increase in the abuse of heroin, an illegal drug whose abuse-related deaths have recently skyrocketed.
One of the biggest discussions in connection with opioid abuse is centered on increased access to the opioid reversal agent, naloxone (see related story, page 23). Legislation on the prescribing of naloxone varies greatly from state to state. Some state protocols dictate that pharmacists can dispense naloxone without a prescription only after completing certification programs. Many of these protocols dictate that the patient’s physician be notified within 15 days of dispensing to allow for the generation of a prescription. This prescription allows the pharmacist to receive reimbursement for his or her services. Other states have granted pharmacists prescriptive authority to initiate naloxone without a diagnosis in association with a collaborative practice agreement. Without a diagnosis there is no prescription, which leaves the pharmacist without reimbursement for their time spent in assessment, education, and initiation.
This is very concerning to pharmacists because reimbursement is crucial to the ability to perform clinical services. Another concern is that providing readily available opioid reversal agents will only encourage the reckless use of prescription medications. However, the literature actually supports the use of naloxone and that naloxone administration correlates with increased rates of treatment-seeking behavior.
Practice prospects
Another discussion point that was of particular interest to me as a soon-to-be new practitioner was the state of the job market for pharmacists. Although new schools and colleges of pharmacy continue to be established, it is hard to accurately take the pulse of the pharmacy job market due to a lack of comprehensive reporting systems nationwide.
As noted in the Pharmacy Workforce Center’s 2014 National Pharmacist Workforce Survey, on average, pharmacists are spending an increasing amount of time providing clinical services compared to dispensing functions. This shift in practice can only make pharmacists more valuable in the health care setting.
Another factor that could positively influence pharmacy practice is the growth of accountable care organizations (ACOs). With pharmacists embedding themselves in ACOs, there is hope for an increased demand for pharmacists’ services. Prospects outside of the traditional community or health-system settings are also garnering attention. From the growing list of new pharmacy specialties to careers in association management, opportunities for pharmacists are expanding.
Eight years after I made the decision to become a pharmacist, I couldn’t be prouder of the profession I have chosen. The future of pharmacy is bright for established practitioners and new practitioners alike.