IAM2: A United Path to Better Pain Management

Alyssa Lagasca 

Pharm.D. Candidate at Notre Dame of Maryland School of Pharmacy 

Class of 2024


#IAM2, I Assess Monitor Manage, is a collaborative outreach campaign created by MPhA (Maryland Pharmacists Association) and supported by the Cardinal Health Foundation. The outreach’s primary goal is to bring together prescribers, pharmacists and patients to mitigate opioid misuse and abuse. Join the campaign and sign our pledge.


According to the National Institute of Health, Maryland is ranked as one of the top five states with high instances of opioid-involved overdose deaths in the United States. In 2018, there were 33 out of 100,000 patients prescribed to opioids who died of an overdose statewide.


A key to positive outcomes in the medical system is the collaborative effort between the physician/prescriber, the pharmacist and the patient. Health care professionals possess the ability to provide physical and mental relief. They have the tools to create the framework needed to initiate treatment and maintain patient compliance. The physician has the initial encounter with the patient in addressing their chief complaint. They then determine what the best mode of therapy would be for the individual. This information is relayed to the pharmacy via a prescription order. The pharmacist evaluates the appropriateness of the medication, dispenses the prescription and concludes with patient counseling. Adherence is often an issue due to communication discrepancies between the physician, pharmacist and the patient. In order to improve medication compliance and reduce potential overdose deaths, there needs to be an established line of understanding between all stakeholders involved. 


For example, opioid prescriptions have been a long-time therapeutic solution for pain. management. But there are stigmas attached to this therapeutic class such as drug misuse, abuse and overdose. In 2019, the CDC published guidance for pain management that looked at alternatives to opioids as the first line of treatment amongst patients. The complex repercussions associated with opioid use not only affects the patient, but also how pharmacists and providers communicate in these situations. The CDC guidelines for prescribing

opioids are meant to improve communications between the provider and patient in navigating their pain management. 


These guidelines can be found in MPhA’s resource center on pain management which includes FAQs, research, and training resources for health care professionals. MPhA has created this resource page to encourage all stakeholders to participate in #IAM2 and promote overdose prevention in the state of Maryland. 


MPhA has compiled a website of tools, resources and studies to support pharmacists, patients and prescribers and to reduce opioid misuse, abuse and overdoses. The abundance of opioid management resources from national and state entities is meant to inspire and guide clinical decisions, but also enhance communication between stakeholders - the physician, prescriber and patient. 


Pharmacists in Maryland play a role in reducing opioid overdose by having an

understanding of  and utilizing the Naloxone standing order and raising awareness about this standing order to other stakeholders. This order was first issued in 2015 which allowed pharmacists to counsel  and dispense two doses of Naloxone to patients as well as their loved ones without a specific provider’s prescription and continues today. 


The communication between patients and health care professionals can also benefit from having follow-up pain assessments. For example, if patients display behaviors that insinuate opioid dependence or lack of pain management, then pharmacists and prescribers can evaluate those gaps in care. Providers play the role of being the first line of communication in pain management therapy. Education of the patient on specifics such as expectations set during their opioid therapy is essential for enhancing patient understanding and establishing trust. 


Patients not only desire support when it comes to tapering off their opioids but they seek emotional comfort. It is important that providers and pharmacists remember the patient is the one experiencing these uncomfortable sensations. Pain brings on physical discomfort which can further branch out into emotional distress, feelings of helplessness and even a decline in mental health. So it is essential during patient counseling that health care professionals display empathetic behavior towards their patients and their struggle over their pain management regimen. Providers and pharmacists can even discuss in further detail with their patients non-pharmacological methods of pain relief such as meditation, acupuncture or prayer along with their opioid therapy. If pain is not properly managed then it can lead to the stigmatized occurrences associated with opioids such as misuse, abuse and overdose. These experiences can mentally damage and even traumatize patients. Therefore, the way that prescribers and pharmacists communicate about the therapeutic well-being of a patient can have a significant effect on the outcome. 


IAM2 is an initiative meant to benefit all stakeholders involved in pain management and opioid therapy. Prescribers and pharmacists will be able to apply the methods discussed in IAM2’s resources from the first day of initiating opioid therapy to monitoring the patient’s pain management. The general public of Maryland can also contribute to preventing opioid overdose deaths by taking advantage of the Naloxone standing order and getting educated by pharmacists on how to save a loved one suffering from an overdose. Lastly, the health care team will be able to address how a patient is dealing with their pain management then evaluate how it mentally and physically affects them. Once we start seeing optimal outcomes for patients’ pain management and reduced opioid-overdose deaths, those results will show the profound impact that IAM2 has on the state of Maryland.


Patients, pharmacists and physicians are encouraged to support the #IAM2 campaign’s pledge, which  states: “I pledge to Assess, Monitor, and Manage (IAM2) opioid prescriptions as a patient, pharmacist or prescriber. I understand that together we can manage pain in a way that reduces stigma and seeks to avoid opioid misuse, abuse and untimely deaths.”  


Please sign the pledge. Together, we can advocate and support optimal health

outcomes, patients reaching their pain management goals and reducing opioid overdose deaths.



Citations

“Opioid Summaries by State.” National Institute on Drug Abuse, 17 May 2021,

www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state.


“Resource Center | Drug Overdose” Centers for Disease Control and Prevention,

27 June 2019, www.cdc.gov/drugoverdose/resources/index.html.


“CDC Guideline for Prescribing Opioids for Chronic Pain | MMWR” Centers for

Disease Control and Prevention, 2016, www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.


“Optimal Prescribing for Pain Management.” Maryland Pharmacists Association,

2021,

www.marylandpharmacist.org/page/painmanagement.


Maryland Department of Health. Statewide Naloxone Standing Order, Guidance

for Pharmacy Dispensing. MDH Overdose Response Program, 2019.

https://bha.health.maryland.gov/Documents/Standing%20order%20guidance%20edited%205_29_2019.pdf, PDF file.