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Rebecca (Becky) Hoss, PharmD, BCPP
Senior SUD/Pain Pharmacist
UC Davis Health
Sacramento, CA

As a substance use disorder (SUD) pharmacist, I am frequently asked why I do what I do. I commonly reply, “I do it for the goosebump moments.” If you have ever been given the privilege to be a part of another person’s recovery, you may know what I mean by this. I am honored to advocate for, learn from, and nurture one of the most vulnerable and stigmatized patient populations in our healthcare system. The truth is my job may be the best kept secret in pharmacy.

How do you establish your value as a pharmacist in a SUD/buprenorphine clinic?

Pharmacists are uniquely positioned to be an essential part of the patient care team at a SUD/buprenorphine clinic. There are a multitude of ways to justify this role and it is not just about preventing medication related adverse events, although that is certainly on the list. Most notably, we improve patient retention rates in the program, increase provider availability by offloading provider tasks and follow-up visits, increase patient and provider satisfaction, and reduce barriers for access of lifesaving medication.

How do you coordinate prescription management with your supervising psychiatrist?

I work under a collaborative practice agreement (CPA) for management of all medications related to SUD(s) and/or withdrawal management. The supervising psychiatrist and I meet weekly to examine our patients’ progress and discuss plans of care. For buprenorphine refill management, patients are reviewed weekly through the state’s prescription drug monitoring program (PDMP) and I utilize an Excel form to assist with tracking prescription due dates. I work proactively to prevent our patients from running out of medication on a weekend or holiday. This review also allows me to monitor if our patients are actively engaging in our program or if they may need additional provider support.

What are your recommendations for the initial visit with the patient and the diagnosing provider?

In our clinic, the initial intake visit takes place with the patient and the diagnosing provider. The provider determines the diagnosis and initial plan of care. They may wish to consult the clinical pharmacist for assistance and coordination of buprenorphine induction and maintenance, withdrawal management and follow up. Or they may consult for general medication review and recommendations.

How do you select which patients are best for the clinical pharmacist follow up or maintenance visits?

Medications for addiction treatment (MAT) are highly effective and no doubt lifesaving. As the clinical pharmacist specializing in MAT and withdrawal management, I act as an additional provider to reduce barriers and improve access to treatment of SUD(s) with MAT. I currently co-manage all patients on buprenorphine for opioid use disorder. Additionally, if patients require more frequent medication monitoring, need multi-step medication adjustments (e.g., buprenorphine micro-induction, withdrawal management, antidepressant optimization) or even if prescribing providers have limited appointment availability, the clinical pharmacist is well suited to complete the follow-up visit as it relates to medication management. All patients could benefit from interactions with a pharmacist.

How do you feel that PGY2 psychiatric pharmacy residents could benefit from integrating themselves into SUD/buprenorphine clinics?

SUD/buprenorphine management provides a valuable opportunity for PGY2 psychiatric residents to be fully integrated into the patient care team. Fortunately, or unfortunately, the need for SUD treatment is growing. As clinical pharmacy specialists in this niche area of medicine, they are well positioned to advocate for and build new pharmacist managed ambulatory care clinics or inpatient service lines. Through research projects, medication formulary management, and provider collaboration and education opportunities, the PGY2 psychiatric resident is a vital resource for our interdisciplinary team.

What are the limitations of being a pharmacist in a SUD/buprenorphine clinic?

The goosebump moments can also come with heartbreak. I witness people regain their lives, reignite relationships, develop connection(s), find meaning, and obtain housing and work. Conversely, I also witness true suffering. Emotionally, this can be intense work. I find myself frequently navigating very difficult conversations. For me, however, the benefits far exceed the risks. I simply love what I do.

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