Psychiatric pharmacists are increasingly playing a pivotal role in enhancing treatment for substance use disorders (SUD) by collaborating closely with interdisciplinary teams. This collaboration includes professionals such as physicians, case managers, social workers, and counselors, all working together to improve patient outcomes. Ashley Maister, PharmD, BCCP, from the US Department of Veterans Affairs, and Aaron Salwan, PharmD, MPH, BCCP, from Montefiore Nyack, shared insights on this topic in a recent discussion with Pharmacy Times.
During their conversation, Maister and Salwan emphasized the importance of team-based decision-making, particularly when it comes to medication adjustments that may influence patient behavior or treatment outcomes. Salwan pointed out that while they may have effective medication strategies, the lack of access can hinder progress. He noted, “We could have the best idea for what medicine could be helpful, but if the patient has no way to access it, then it’s not useful at all.”
Collaboration Across Disciplines
The interaction between psychiatric pharmacists and other healthcare professionals is essential for maintaining continuity of care. Salwan highlighted the significance of his relationships with counselors and discharge planners, stating that these connections help prevent lapses in care as patients transition between different phases of treatment.
Moreover, when pharmacists observe behavioral changes in patients, they engage in interdisciplinary discussions rather than solely approaching physicians. Salwan explained that this collaborative effort allows all team members to weigh in before making clinical decisions, fostering a supportive environment for patient care.
Barriers to Effective Practice
Despite the clear benefits of their involvement, psychiatric pharmacists face several policy barriers that hinder their ability to fully contribute to SUD treatment. Maister noted that restrictions on prescribing authority and limitations surrounding DEA licensure can disrupt the continuity of care. “With the removal of the X-waiver, allowing psychiatric pharmacists, especially those working in SUD clinics, to prescribe buprenorphine or controlled substances would improve continuity of care,” she stated.
In their respective states, pharmacists encounter stringent requirements that complicate their ability to obtain the necessary licenses. For instance, Maister mentioned that in her practice, regulations prevent pharmacists from holding DEA licenses in certain states. This inconsistency adds complexity and expense to their roles, limiting their potential impact on patient follow-up.
Salwan echoed these sentiments, emphasizing the need for expanded prescribing privileges and reimbursement pathways. He mentioned recent changes allowing pharmacists in various states to administer long-acting injectables but pointed out that reimbursement issues still inhibit broader adoption of such services. “Many of the skills pharmacists provide aren’t always billable or tied to a diagnostic code,” he noted, indicating a pressing need for systemic changes to support psychiatric pharmacists in clinical settings.
The discussion also highlighted the need for increased support of addiction and harm reduction services. Both pharmacists advocated for the expansion of resources such as sterile syringe programs, drug testing devices, and access to naloxone. Salwan remarked, “These are things we can never have enough of given the needs of our population.”
Overall, the insights shared by Maister and Salwan underline the substantial value that psychiatric pharmacists bring to the treatment of substance use disorders. Their expertise, when integrated into healthcare systems, not only enhances patient care but can also lead to cost savings within the broader health system.
