CEimpact Podcast

Harm Reduction Strategies to Save Lives

Share episode

In this episode, we explore the vital role pharmacists play in harm reduction strategies in pharmacy practice. Discover how pharmacy-led initiatives and interventions can save lives and transform pharmacy practice. Join us as we discuss opportunities, challenges, and actionable steps for integrating harm reduction into your pharmacy practice site.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Lindsay McCoy, PharmD, BCPP
Pharmacy Manager
Village Drug Shop at Advantage
 
Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Explain the importance of harm reduction in pharmacy practice.
2. Identify key harm reduction strategies and steps for their implementation into pharmacy practice sites.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-291-H04-P
Initial release date: 11/4/2024
Expiration date: 11/4/2025
Additional CPE details can be found here.

Follow CEimpact on Social Media:
LinkedIn
Instagram

Speaker 1:

Hey, ce Plan members From CE Impact, this is Game Changers. I'm Jen Moulton, president and Founder of CE Impact. If you're an avid listener, you know I've served as your host for quite some time now and the time has come to pass the reins to one of our very capable and gifted pharmacists, josh Kinsey. Dr Kinsey has been with CE Impact for more than three years now and is the mastermind behind our course content and curriculum. I'm so excited he's agreed to host the podcast because I think you are all going to learn so much from him and from all of our guests.

Speaker 1:

But before I pass the torch to Josh, I wanted to get in a shameless plug for subscribing to Pharmacists by Design if you don't already. You can get CE for this podcast plus so much more for less than $10 a month. You're already listening, so there's no reason not to claim CE credit for learning. Check out the link in the show notes or go to ceimpactcom to enroll. Okay, back to the episode. It's been a pleasure to serve as your host and now I'm honored to pass the mic to Josh. Take it away, my friend.

Speaker 2:

Hey, CE Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and, as always, I'm excited about today's discussion. In this episode, we're discussing the critical role of harm reduction strategies in pharmacy practice and how they are saving lives. We'll explore how pharmacy-led initiatives like needle exchange programs, utilization of fentanyl testing strips and the use of opioid overdose reversal agents are transforming patient care. We're going to learn more about how pharmacists can integrate harm reduction into their practice to provide life-saving services to their patients and communities. And with that I'd like to welcome our expert guest, Lindsay McCoy. Lindsay, thank you so much for taking time with us today to explore this topic of harm reduction in pharmacy.

Speaker 3:

Glad to be here.

Speaker 2:

For our learners if you can take just a couple of minutes to tell us a little bit about yourself, your current practice site and why it is that you are passionate about harm reduction and pharmacy practice.

Speaker 3:

For sure. So I have been in this space for nine and a half years and we are an independent retail pharmacy in our community mental health center in Athens, georgia, and within that over time we've been able to build programs. And I say we, as really it's the clinic, it's the agency have built those programs. But I feel very excited and honored that they have really brought us into those programs and the biggest one that we have is our opioid use disorder program, which it's a peer run program. So it's fantastic and they've been recognized and in various conferences across the United States and doing awesome things for our patients.

Speaker 3:

So being able to work with them is where it all started for me, kind of opening up to harm reduction and understanding what it is and how we can be involved in our space in the pharmacy. And again, I'm here in the clinic. So the conversation's already open a little bit, but it just. I think my role in it now is to roll it out to other places where the conversation might be a little awkward and a little uncomfortable, but still being able to have it and knowing what to do and when to you know how you can still care for patients and people who use drugs and make sure that they're maintaining their health as much as possible.

Speaker 2:

Yeah, that's great and I think you know, I think that's the goal of today's episode is to enlighten our learners, inspire them, hopefully, and also empower them with just a few, you know, take home points that you know. I think that the idea of harm reduction is so big and broad and can be overwhelming, and so I really want our learners to walk away with something tangible today that they feel like, okay, I can do these few steps you know, and continue to just kind of grow and build and network and expand. So that's great. Thanks again for joining us. It's super great to have you with us. Let's jump into kind of just an overview of harm reduction. So when someone says harm reduction, what do we mean? If you can just kind of maybe define it a little bit, I know there are some core principles that go along with the idea of harm reduction. So if you can share just a little bit of background information on the whole harm reduction process, yeah, so I'll just start.

Speaker 3:

there's actually great resources at harm reductionorg and that's the National Harm Reduction Coalition, so they have published eight core principles of harm reduction. I'm not going to read out all eight of them, but essentially the highlights are that we know that people use illicit substances. We know that using illicit substances is harmful in various ways, whether that's risk of overdose, risk of spreading diseases through, you know, dirty needles, other things, wound care or inappropriate wound care. There are consequences beyond just the drug use itself, and so it's really just working to minimize those harmful effects. In the setting of a person who uses drugs, and the big phrase of everything with it is meet them where they're at. You don't try to look at someone and say you should really stop using drugs. Well, chances are they know that. You know addiction is a disease and they're just not. They're not there, they're not ready. So what are the things that we can do to support them being the safest and healthiest around what they are currently doing?

Speaker 2:

Yeah, that's great. Thanks for sharing that resource too. I think that that, you know, is something our learners can also walk away with. Is, you know, checking out harmreductionorg and really kind of expanding their knowledge and their comfortability around the space? So that's great. So with that it's probably not easy to do. But if you could summarize what's the role of pharmacy in harm reduction, what should we be considering and doing in this space?

Speaker 3:

I like to think of our role, kind of like that, in immunizations.

Speaker 3:

We know that we are going to offer immunizations to people based off of their age, current disease states, social habits like smoking, anything like that, because we know that we can reduce the risk of consequences due to these illnesses. So in that way of healthcare, why wouldn't I try to promote someone being healthy? And so within that what we have done I mean, we don't dispense a lot of opioids for pain or high dose opioids or high quantity opioids, but every single person that we do, we talk to them about Narcan. We got Narcan in their hands and that's at least a place to start, because then they are aware of it. We encourage them to make sure their family members, anybody who visits them regularly knows about it, knows what to do and what to look for, and so really it's about having a conversation Beyond that. I don't know about you, Josh, but I've heard the person come to the pharmacy window and say my grandma's visiting from out of town and she forgot her insulin needles. Can I buy some?

Speaker 3:

Oh yeah, that is probably the most common phrase that you hear, yeah, so then I know what the response was in those that I have worked under and the kind of general idea and approach to that situation which you know I don't know in your history if you've kind of gotten this, but it's it's kind of an interrogation at that point oh, what kind of insulin is she on?

Speaker 1:

Where does?

Speaker 3:

she fill it, bring me the bottle.

Speaker 2:

you know everything like that, so you know there's Shoulder bond needle, the C. Yeah, Exactly, yeah, Yep.

Speaker 3:

So that kind of interrogation is really deterring people from getting clean needles they're gonna find a way to use, so why would we prevent them from getting a clean, accessible source and prevent spread of HIV Hep C? So you know, from that side of things, that's an impact Now that can be restricted and impacted by state regulations.

Speaker 2:

Absolutely.

Speaker 3:

And you know being very aware of the wording of state regulations and how they're approached. But my big thing is if you don't feel comfortable doing it, know someone who is know a resource. Know somebody in your local community that, if you are't feel comfortable doing it, know someone who is know a resource. Know somebody in your local community that if you are not going to be able to provide needles to somebody, then is there a certain service in your area, is there a needle exchange, anything like that, to help them?

Speaker 2:

Because if you're just automatically turning them away, then they're not going to feel good about anything at that point and you know potentially have more negative yeah, and I mean, and like you said it's, it's not like you, you know, denying them that bag of needles is going to stop them from from doing it anyhow like they're going to find a way and why not, you know, be that source of providing the clean needle. Yeah, I completely understand. I feel like that's a great, a great first step. I think that every single pharmacist in the country has probably had that interaction with a patient.

Speaker 3:

It's a huge shift in mindset. Yeah, when you have that approach, and so that's really just the one of the biggest things that I would encourage folks to reevaluate is what are you harming versus what are you helping by? By the practice of just automatic denial of somebody getting clean syringes yeah again. You know regulations, laws, everything like that aside yeah, no, you know sometimes you're kind of held to that. But um, you know, also knowing, knowing, what your rules don't say.

Speaker 1:

So in georgia it's you know, we can tell them for a therapeutic purpose, you know.

Speaker 3:

If they don't say what they're using it for, I don't have to ask.

Speaker 2:

Yeah, you're right. You're right I mean it's true because it's you know. Again, ensuring that you know your state laws and rules, but, like you said, also understanding you know what is. What are the benefits of me doing this versus not you know, like out just weighing, weighing the pros and cons of it and seeing that it makes sense? So, yeah, that's great.

Speaker 2:

Okay. So some additional opportunities for pharmacists and our team members to kind of get into this harm reduction space. So you know, we've we've talked about the needle needle exchange knowing someone else if you do not feel comfortable, and that's okay too. You know we've talked about the needle needle exchange knowing someone else if you do not feel comfortable, and that's OK too. You know it's, it's OK to to be to be the one that that doesn't feel comfortable with. That I get that. But, like you said, being sure that you've done your homework, who in your area is comfortable with that? What opportunities are there so that you can share those with that patient as well? So, yeah, that's great. So are there any other opportunities for pharmacy teams to be in the harm reduction space? Like what are some of the other things that we can kind of dip our toe into?

Speaker 3:

Yeah, so something that we have here is we sell fentanyl and xylosine test strips. We sell fentanyl and xylosine test strips, and so those would be used to test a small amount of the drug supply, the drug substance, to see if there's fentanyl present or xylosine. So xylosine, if you haven't heard of it's kind of in the family of clonidine and it's used as a sedative in veterinary surgeries.

Speaker 2:

Oh sure.

Speaker 3:

Not controlled. It's very accessible. There's kind of the thought with it being added in, it attenuates the high of opioids and kind of makes it last a little bit longer. But also it means that you know, being used as a sedative in surgeries, it's also going to cause problems if it's, if it's used too much otherwise. So it causes heavy sedation.

Speaker 3:

And in combination with fentanyl, you've got the perfect storm for an overdose.

Speaker 3:

And dialysine doesn't respond to naloxone as easily as an opioid would.

Speaker 3:

So you still have someone who's sedated and, and you know, knowing that they have xylosine in their supplies is important for them to know how to respond and know how to approach their, their use. So we do the the test strips and of course in our program again, we're in the clinic so we have a lot of resource. So even if we don't have them in stock or something, we can usually find someone in the building who does. But it's been really interesting to kind of help my staff understand what they're for and be able to talk to patients about it, like I love when someone just asks, like what's a fentanyl test strip? You know like what, what is that? And just you know my staff being able to talk to them about it and know and understand and kind of tell them why we we have it around and why we offer it. And then beyond that we have a little program that it's kind of like if you've seen, you can like pay it for and buy a cup of coffee for somebody.

Speaker 3:

Oh, sure you know who maybe can't afford it, and so yeah, so we do that. We have a pay it forward program where people can buy these fentanyl or xylosine test strips and we keep them to the side. And so we have people who every now and then they come up and they say, hey, I don't have any money, can I? Is there a fentanyl test strip available so they can still access it and not have? I mean, the cost of it's pretty low, I mean the dollar.

Speaker 3:

OK it is like around a dollar fifty maybe.

Speaker 2:

So so you sell these like it's not like a box, a hundred, like it's like an individual strip, right?

Speaker 3:

Yeah, we sell them just individually, so people can get as few or as many as they want, or donate to the donate to the, the pay it for jar.

Speaker 2:

Yeah, okay. So so I'll be honest. This is these are new since I've been in practice, you know, in this space. How exactly does it work? Do you just like dip? I mean, how do you actually test?

Speaker 3:

Do you dip medication on it or?

Speaker 2:

you know, how does that work.

Speaker 3:

So most of the time and I know in the ones that we get specifically, there's a QR code that links to a video. So there's all kinds of videos online that people can look at and I would encourage you to to just take a look and see what it, what it looks like, to use them just to help coach people through it. But essentially they take a small amount and we actually we have the little spoons that they can like, get the small amount of sample of their substance and they would put it in, you know some, something small like a bottle cap, and put in some water with it and mix it, and then they would use that test strip to to test the liquid that they've mixed in their substance. So most of the time, opioids around here, at least you know, they have fentanyl in them. So it's not necessarily that we are concerned about people who use opioids having fentanyl.

Speaker 3:

We're pretty aware that most of the supply has fentanyl in it. At this point, if people are using opioids, I'm recommending those xylazine test strips so they are aware that xylazine is in the supply. The fentanyl test strips we more so recommend if they're using other substances, if they're using methamphetamine or ecstasy, anything like we've seen just so much. We've had reports of so many things like with fentanyl in it, where they just had no idea. So that's another thing is it's kind of it's in a weird space of a pharmacy, of like it's it's drugs, but not the way that we're used to learning about.

Speaker 3:

You got to learn about drugs in a different way.

Speaker 2:

Yeah, yeah. And again it goes back to the idea that, you know, unfortunately the patients may not be in a space where they're ready to talk about, you know, quitting, or where they're ready to talk about stopping the practice that they're doing, and so it's more. It's more about making sure that that what they are doing is as safe as possible. You know, basically, yeah, yeah, that's um, it's really fascinating. I mean, it's it's really interesting that that we have that advance and and that technology to kind of do that. So it's really it's great. Thanks for sharing that. You.

Speaker 2:

You have enlightened me, because I have heard lots about fentanyl test strips but honestly, I did not know necessarily how they exactly worked. So this is great information for me as well. Ok, so let's talk a little bit about, maybe, some opportunities to collaborate with others. So let's say that you are a small pharmacy, you're busy, you just you don't have time to like really kind of roll out a lot of initiatives or new services or whatnot. What are some opportunities to collaborate with others around that do have strong harm reduction policies or processes in place?

Speaker 3:

To the harmreductionorg. They have locators on the website as far as syringe service programs and where you can get stuff like that. So, again, knowing the resources in your area if you're in a rural spot, probably not going to be as robust with the services that may be around for SSPs, but we have one here in Athens and so that's something that thankfully. I've worked with a person who started the syringe service program we have here in town and so if there was ever anything kind of where I had somebody that I said unfortunately I'm not able to help you with this, but let me tell you you can, so I could just you know, I have some of their business cards and their stickers and their flyers. Just keep them around and honestly, it's opened a lot of questions. We have a sticker on our register so people will ask what's that and what does that mean, so just kind of having that information. There's some national types of programs. There's several lines where you can fall in to this 1-800 number, this anonymous line, so people aren't using a loan.

Speaker 3:

And so just having that posted somewhere. Never use a loan. Having the phone number posted is a way because that's, you know, an opportunity to help make sure that somebody is not unintentionally overdosing and when they're alone, have no one to respond Services like that. If the person doesn't respond, they call for emergency services. So just trying to, you know, and meeting with people, just, you know, trying to see who in the area you can talk with. There's probably more recovery homes in your area than you're aware of.

Speaker 3:

I feel like even in Athens and our surrounding areas, I learn about a new recovery home or program at least once a month. So going to them and saying like, hey, I'm a local pharmacist and I want to make sure that I'm helping the community in the best way and in the realm of harm reduction, you know how can I help. Are there some things that you know? What services do you provide in your organization, kind of understanding what they do? So if you have somebody who's curious, you can at least say, hey, I talked to these folks. Folks, go check them out.

Speaker 2:

Yeah, yeah, that's great. Thank you for sharing. So one thing I want to touch on and then I'll move into another one. I've already my wheels already turning of all the different things I want to ask you. So one thing, really quick, is do you see this is not going to necessarily sound right Do you see repeat customers Like, do you building trust with patients with these harm reduction strategies?

Speaker 3:

yes, so there's at least one person in particular who I actually had it on my mind that I needed to reach out to this individual because I haven't heard from them and I'm concerned. But this person calls and they ask for me specifically, know that that happens and everything, but when they call you know they'll say hey, it's so, and so I'm curious if you have any diabetic syringes, and you know so we just, with that conversation, I've talked to this person several times and said I don't want you to be unhealthy, so I'm I'm always going to either help you get what you need.

Speaker 1:

If.

Speaker 3:

I can't do it myself, I will. I'll make sure that some somebody around can, whether it's a resource in this building or this, you know, community, this town, like I will make sure that you get what you need.

Speaker 2:

Right, yeah, yeah, that's that's. It's interesting that you know this is an area where we're talking about building trust with patients and where we where we want that because, again, you know, we never know when a patient is going to be ready to make a decision to change and if we've built that trust and we've gained their respect, then you know we can also, we can be a part of that process too.

Speaker 3:

So, yeah, and another just like tiny side thing is I have somebody who's a repeat customer for Narcan because she lives in a space that is people use drugs all the time. She has had to witness overdose and been a part of you know, administering narcan to somebody who's in active overdose and so she she's a repeat customer because she's she's out there giving them out and she's out there making sure that everybody around her has some and that she's got some on her at all times.

Speaker 2:

She's her own harm reduction system.

Speaker 3:

Absolutely yes, yeah, she's, yeah and I mean she's. She's brought people up to the pharmacy that we didn't even know or you know whatever, but they were just kind of doing something else around the clinic and she'll just be like hey, I've been talking to this person and they need some Narcan. They want to get some Narcan.

Speaker 2:

Wow, what a great advocator for the community.

Speaker 3:

Yeah.

Speaker 2:

That's awesome. So one thing I want to touch on briefly in our last few minutes. So some of the challenges. Obviously there is, you know, to be frank, there's stigma associated with pharmacists being in this space. There are people who think, oh, how could we have a space where we just let them come in and watch them inject in a safe space so that we could administer? How can we support quote unquote in that way? So maybe touch on just a little bit about and you have a little bit of what are the benefits of that, you know, again outweighing everything, but just kind of touch on the stigma and why it's important that pharmacists need to embrace and be in this space.

Speaker 3:

Yeah, it's tough. I felt a shift in myself even, like from being in pharmacy school and working at a couple of different pharmacies and witnessing those types of interactions with pharmacists as far as just the the cell of a needle. Sure it was kind of eye-opening to to get to work with people in recovery and be on the other side of things with them, of the side of them telling me about stories where they were treated like trash and and they felt like like a shell of a human because they could feel the judgment from somebody who they were. They were going and trying to get a clean meal so they didn't harm themselves further with something they know is harmful.

Speaker 3:

You know, they know it's harmful, but they're trying to do something good for themselves. And then you have someone who's a health care provider and and this is across you know all facets of health care sure whether it's the er. You know, there's still that stigma.

Speaker 3:

There's still people who look down and judge passing passing judgment yeah and just being able to kind of work on on the flip side of that and help them understand like we're I am here for for you and your health. I want you to be healthy in the ways that you're going to be healthy, just like I am going to go teach a diabetes education class in an hour and we're going to talk about eating habits and healthy eating, and I do it while somebody is opening a bag of Cheetos and somebody else has opened up a Snickers. So you know like we're still witnessing a harmful behavior. We know it's harmful, but we'll. You know we have to kind of break down the ideas of picking and choosing the harmful behaviors that we want to allow and the ones that we don't want to allow.

Speaker 2:

Yeah, I mean, I know that. You know, eating a lot of sugar and sweets is not the best idea for me for health reasons and for the fact that diabetes runs in my family. But guess what? I love ice cream and I I still do it, but I, you know, it's the same type of thing. I know it's bad as I'm doing it, but I'm still doing it.

Speaker 3:

So it's really the same idea. Imagine going going to the grocery store and saying could I please have some rocky road? And then saying well, what brand, what fat content what you know like that I, just I. Or when's the when's the last time that?

Speaker 2:

you, you bought some, you know. Like that, I just or when's the when's the last time that you, you bought some you know, or whatever right, like yeah how often do you eat that?

Speaker 3:

wow, you know like that's such a great example, lindsay, wow, yeah um, but yeah, just being made to feel that way was something that you already know you. It's not the best choice, but that's again back to addiction and the process, and it was not. You know, for most people it's not an overnight road that gets them there. It's a pathway and it's not going to be an overnight jump out of it. It's a long road and, just like I said before, meeting them where they're at is the best chance of helping them be healthy with what they're currently doing and having a chance of being someone who does end up in recovery and can move forward without drugs.

Speaker 2:

And, and you know, as we said earlier, we touched on briefly who's to say that you, doing that one act of you know, whatever providing the needle, providing the test strip, providing education, support, whatnot who's to say that A either that's maybe building trust and respect, that they are going to continue to come to you and open up to you and be ready to discuss options of recovery with you, or that it's going to support them enough to where you know they do. It may not be with you, but they're trusting a healthcare provider again and they're, you know, they're opening up in that way. So you know, who's to say that our one little act of something is just not going to, you know, continue to grow and expand and really help a patient in the long run. So, and really help a patient in the long run, so, yeah, okay, this is all so good. I just I love the example of now. I'm gonna have this whole idea in my head when I go buy ice cream again, about how it's the same thing of being judged and whatnot. So, so good.

Speaker 2:

Well, lindsay, we are running out of time, but harm reduction is a game changer. We do need to embrace it as a practice, as a profession, as a group of individuals who are supporting our community. So, as I always do, I want to sum up the episode with the game changer. So tell us what's the takeaway for listeners today on harm reduction, what is going to really change their practice? What can they do? What are the small steps that they can do to make a big ripple effect?

Speaker 3:

Well, I guess the thing I always like to make sure that I am doing myself and telling others is if you can't do it, find out who can. You can't do it, find out who can, and never let your ideas or your inability to access something, whether that be a syringe service program or test strips or you know any anything. I think narcan is a lot more readily available, obviously with it being over the counter but, you know, like if you're in a space where it's not stocked or it's still expensive.

Speaker 2:

Yeah.

Speaker 3:

Where you know, know the resources, know your resources for these patients who are I mean, they are your patients, their people, their, their, your community and understand how you can help them get access to resources and just be a facilitator for that. And helping them understand that you care for their health and that's part of you working in those ways is to help with access to safe supplies, to safe use habits.

Speaker 2:

That's great. Well, Lindsay, that's all we have time for. Thanks again. I feel like we could go down the path of harm reduction strategies for hours and not touch on everything, so thank you so much for your time. This has been so enlightening and helpful. If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week. Until next time.