Integrated Behavioral Health and a Family Practice Provider collaborate on patient care.

By Dr. Matthew Bertsch, PharmD. and Dr. Chinwe Chukwurah, M.D.
Sun Life Family Health Center

The opioid crisis has had an effect on many people around Arizona, and around the country. Although the problem with opiates is not a new one, it certainly has developed much traction recently. With governors, legislators, our national congressional representatives, our senators and even our president talking about the issue, it has garnered a lot of mainstream attention. Opiates/opioids, often used interchangeably, are not new, and neither is drug abuse. However, the attention on the crisis has made health care challenging, even to Sun Life Family Health Center.

Patient education
It really is not all about the opiates though. Drug abuse, legal and illegal, has run rampant for decades. People who abuse have abused promethazine with codeine for its pleasurable and sedative effect; have abused dextromethorphan for its mild euphoria or extreme hallucinations depending on dose; and have abused other medications meant to treat neuropathic pain for its marijuana-like effects. Drug abuse is not new.

The laws and technology in our state have changed, and there is now an Arizona Controlled Substances Prescription Monitoring Program for the safety of patients. Prescribers are now required to check the prescription monitoring program. Prescribers will also be required to prescribe addictive medications electronically. Continuing education will be required for providers as a part of maintaining their license. Prescription doses will also be limited and new opioid packaging requirements have been implemented.

The scrutiny around opiate prescribing has led to opioid refugees, those who have had to abandon their addictions to prescription opiates and have turned to illegal street drugs. Patients have turned to both methamphetamine and heroin. Because of all of these overdoses, both legal and illegal, access to the life-saving overdose drug naloxone has increased as well.

Sun Life
At Sun Life Family Health Center, we practice pain management responsibly. While our primary care providers have autonomy in pain management, their decisions are guided by policy and proper clinical judgment using guideline-based therapy.

Dr. Chukwurah and Dr. Bertsch consult about Pain Management at Sun Life Family Health Center in Casa Grande.

What makes us unique, however, is our integrated approach to pain management. We have a team of integrated behavioral health specialists who work with our patients, as many times symptoms can be managed at a behavioral level as opposed to prescribing a medication. This is where our Mindful Alternative Pain Program comes into play. MAPP is a series of classes that focus on alternative and natural ways to cope with issues associated with pain.

Clinical pharmacy has made a huge impact on the approach to pain management within Sun Life. Clinical pharmacy has teamed up with primary care providers to review dosing of pain medications of the patients we serve. Clinical pharmacists also provide education to patients about opiates, discuss pain goals with patients, check dangerous drug interactions and consult with providers to ensure proper therapy for patients. The goal of this collaboration is that patients learn to manage their pain and reduce their dependency solely on medications.

Sun Life’s community pharmacists assist in the process by providing a thorough review of the prescriptions sent by the providers to one of our six pharmacies. Although this is not different from how other pharmacies should operate, Sun Life pharmacies have the advantage of being in close proximity to the clinical pharmacy team, the behavioral health team and the primary care provider.

Pain management is a complicated subject. We have seen that with this collaborative, interdisciplinary approach, medication use is decreasing, and there is an overall decreased risk for medication-related problems. Patients benefit when health care providers set an example and work together to ensure proper care of our patients who are in need.

Matthew Bertsch, PharmD., is the director of pharmacy and Chinwe Chukwurah, M.D., is the medical director at Sun Life Family Health Center.

This article appears in the October issue of InMaricopa.