New statewide program in North Dakota aims to stem opioid misuse

Preliminary estimates released by the U.S. Centers for Disease Control and Prevention show a nearly 7 percent increase in drug overdoses in 2017, with more than 72,000 deaths. Of the total deaths, almost 68 percent of them were tied to opioid use. A new statewide program in North Dakota called ONE Rx aims to stem opioid misuse by increasing awareness when patients first fill an opioid prescription.

ONE (which stands for opioid and naloxone education) Rx is an innovative approach to screen and educate patients who receive prescribed opioid medications in participating community pharmacies in the state of North Dakota.

In an earlier pilot program with 107 participants in eastern North Dakota, 26 percent of patients identified at some risk of opioid misuse. Approximately 30 percent of patients in the pilot study identified at risk of accidental overdose.

The ONE Rx project is a collaborative effort of the North Dakota State University School of Pharmacy, the North Dakota Board of Pharmacy, the North Dakota Pharmacists Association and the state's Department of Human Services.

"We know that some people do need prescribed opioids in some circumstances and many are not always aware of the impact the prescribed drugs can have," said Mark Hardy, executive director of the North Dakota Board of Pharmacy. "ONE Rx is designed to equip pharmacists with tools to screen for opioid use disorder, identify patient needs and provide counseling and resources to safely use prescribed opioids."

The project is the effort of multiple partners to proactively help patients and communities. The program received grants totaling $150,648 to make it available in the fall of 2018. Funding from the North Dakota Department of Human Services, the Alex Stern Family Foundation and the Blue Cross Blue Shield of North Dakota Caring Foundation made the program possible.

The group enlisted the expertise of faculty members in the NDSU School of Pharmacy to provide statewide continuing education for community pharmacists. The free three-hour training sessions will be offered in several North Dakota cities. Participating community pharmacies also will be provided a toolkit with the resources they need to deliver this program of care. The program covers the science of addiction, opioid use and community support services.

"Opioid misuse is a disease, just like diabetes or high blood pressure or depression. We don't know who's going to maybe go down that path," said Heidi Eukel, associate professor in the NDSU School of Pharmacy. "No one expects after they have surgery, for example, to become an abuser of prescription pain medication," she said.

This continuing education program developed in the NDSU School of Pharmacy will educate pharmacists in North Dakota on a method to screen patients receiving opioids, using an Opioid Risk Tool (ORT). The tool assists in identifying individuals who may be at higher risk of opioid misuse. Pharmacists who are trained to administer the tool can then provide patient care and counseling as needed.

"Community pharmacists have a unique relationship with their patients and are often the most easily accessible health professionals in their communities, particularly in more rural areas," said Mike Schwab, executive vice president of the North Dakota Pharmacists Association. "This program will provide tools to assist community pharmacists to do even more to ensure safe use of opioids."

The One Rx program also will deliver education on the use of naloxone to reverse the effects of an opioid overdose. NDSU School of Pharmacy faculty members Mark Strand, PhD; Heidi Eukel, PharmD; Amy Werremeyer, PharmD; and Elizabeth Skoy, PharmD; along with Jayme Steig, PharmD, of Quality Health Associates of North Dakota, received the grants and will be among those providing the continuing education.

"This continuing education program for pharmacists at community pharmacies in North Dakota moves opioid misuse and overdose prevention to the initial patient encounter," said Elizabeth Skoy, associate professor in the NDSU School of Pharmacy.

The ONE Rx project is an effort associated with North Dakota's State Targeted Response to the Opioid Crisis Grant (Opioid STR), funded by the federal Department Human Services (DHHS), Substance Abuse and Mental Health Services Administration (SAMHSA), administered through the North Dakota Department of Human Services.​