Charles F. Caley, PharmD, BCPP
University of Connecticut
Psychiatric pharmacists know the story all too well. Individuals who live with schizophrenia have difficulty adhering to their prescribed oral antipsychotic treatments during the course of their illness – the CATIE trial reported that, eventually, three-quarters of subjects discontinued their antipsychotic within 18 months of it being started. The consequence of antipsychotic treatment that is stopped is nearly always exacerbation of psychotic symptoms leading to a full-blown acute illness and a hospitalization. From there each person will start back on their road to recovery.
In a country of 300 million people, we have an estimated 3 million individuals living with schizophrenia. A strength of the psychiatric pharmacy specialty is the empathetic drive we have to serve our patients. However, the optimistic estimate of the number of psychiatric pharmacists in the United States is only 2,000. While 2,000 is a much larger number than what likely existed in pre-CPNP days, 2,000 psychiatric pharmacists is not nearly enough to effectively serve the mental health care needs of individuals living with schizophrenia, even if we were optimally integrated into key patient care positions in the health care system nationwide. It is clear we need greater numbers to serve this vulnerable patient population.
In 2010, the US Bureau of Labor and Statistics reported that there were nearly 275,000 pharmacists working in the United States and that approximately 43% (118,000) were employed in community pharmacy. Therefore, opportunities that strengthen connections between psychiatric pharmacists and our community pharmacy colleagues to improve the mental health care outcomes of our patients makes sense.
In March 2017, a paper from NASPA and CPNP was made available that advocated for pharmacists to be able to administer any medication that is on a valid prescription, including, and in particular, long-acting antipsychotics. The paper recommends that training should be made available from an ACPE accredited program and that CE addresses state policy recommendations for pharmacist administration of medications.
In early 2016, efforts began in Connecticut to construct a pathway that would permit community pharmacists to administer long-acting injectable antipsychotics. Without introducing new legislation to revise the current pharmacy practice act, the only vehicle permitting Connecticut pharmacists to administer non-immunization-type injected medications was a collaborative practice agreement between a pharmacist and psychiatrist. [According to NCPA, 8 states currently require a CPA for a pharmacist to administer an LAIA: Maine, Connecticut, Ohio, Michigan, Wisconsin, Montana and Nevada]. Over the course of time, a collaborative practice agreement was authored, a community pharmacy partner (Genoa-QoL) was identified, and a training program was developed. In May 2017, pharmacists from four Genoa sites participated in the first training program. Shortly after this training, pharmacists began administering LAIAs to a small number of patients. Press on this effort was distributed through CPNP as well as here and here.
Presently, there is planning for additional pharmacists in Connecticut to be trained including both Genoa-Qol pharmacies as well as community pharmacists. Eventually, the goal of this effort will be to establish a state-wide “network” that has a capacity to treat a large number of patients.
Connecticut is not the only state where pharmacists are administering long-acting antipsychotics. For example, pharmacists at First Avenue Pharmacy in Spokane, Washington, Our Lady of Peace hospital in Louisville, Kentucky and Lutheran Family Services in Lincoln, Nebraska are administering LAIAs.