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New program helps North Dakota pharmacists prevent opioid abuse

North Dakota Attorney General Wayne Stenehjem, right, made note of how many people who are addicted to opioids said their addiction started after taking a pain prescription after having a dental or medical procedure. Stenehjem also spoke on the ONERx program that the North Dakota State University School of Pharmacy created which he said is a good thing to help prevent opioid abuse. Also shown are, from left, Amy Werremeyer, Mike Schwab and Elizabeth Skoy. Tom Stromme / Bismarck Tribune

BISMARCK—A new statewide program leverages pharmacists in combating opioid abuse in North Dakota.

On Wednesday, Aug. 15, the North Dakota State University School of Pharmacy unveiled a new training program, called ONERx, to educate pharmacists on how to spot patients at risk of abusing opioids, as well as increase the number of naloxone prescriptions pharmacists write.

"None of us are out of the reach of this (opioid) epidemic," Mark Strand, a professor at the School of Pharmacy said at a news conference. "We need all hands on deck in North Dakota to address this problem."

The program was developed by the School of Pharmacy through a more than $150,000 grant from the North Dakota Department of Human Services, the Alex Stern Family Foundation and Blue Cross Blue Shield of North Dakota.

The program provides training to pharmacists on a screening tool to assess risk for opioid abuse among their patients, as well as the science of addiction, naloxone prescribing and provides pharmacists with a localized list of addiction treatment services pharmacists can refer their patients to.

Attorney General Wayne Stenehjem commended the new program, which is supported by the North Dakota Board of Pharmacy and the state Pharmacists Association.

"The feeder system for the heroin problem and the fentanyl problem in North Dakota is the opioid prescription, because we know about 80 percent of people who become addicted to heroin started out with prescription medications," Stenehjem said. "We have a long ways to go, we have a lot to do, but I'm very pleased that the pharmacists of North Dakota are stepping up to the plate."

Mark Hardy, the executive director of the state Board of Pharmacy, called the program "another tool in the chest of pharmacies."

The board provided seed funding for a pilot project last fall to test the ONERx program. In the pilot project, 26 percent of patients were found to be at some risk of misuse and about 30 percent of patients in the project were identified at risk of accidental overdose.

The "innovation" of the program is the screening questionnaire, which allows pharmacists to identify the potential of opioid misuse or accidental overdose, said Elizabeth Skoy, an associate professor at the School of Pharmacy.

"All opioid medications, even if taken as prescribed, do pose a risk for accidental overdose, as well as the potential to develop an addiction," she noted.

After the screening, pharmacists determine what interventions can be made, including talking with a patient about partial medication refills, prescribing to them the opioid-reversing drug, naloxone, and suggesting addiction treatment services.

"Part of the training is also reducing the stigma (of) naloxone and accidental overdose ... and through this (screening) process and our interventions, we might be seeing more prescribing and dispensing of naloxone to our patients," she said.

In 2016, the state Board of Pharmacy drafted administrative rules that allow pharmacists to write prescriptions to anyone for naloxone after undergoing required training. Since then, Hardy said he's seen an "uptick" in the number of pharmacists signed up to prescribe.

"I think we need to ... better educate the patient to request (naloxone), as well, and (for pharmacies) to be open to having that on hand," Hardy said.

Sarah Schmidt, a pharmacist at Thrifty White in Grand Forks, signed up her pharmacy to participate in the ONERx pilot program last fall. She found the program helped her counsel patients on the risks involved with opioid medications, as well as gain confidence in prescribing naloxone. Since the training, she's prescribed it four times.

"I took it as a great achievement to even get four more naloxone kits out in the community," Schmidt said.

ONERx training will be offered in Fargo on Oct. 3, Bismarck on Oct. 12 and Minot on Oct. 13.

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