Community Pharmacy Opioid Risk Screening Assessments: Comparing older adults (65+) to those under 65

Background Older adults are at increased risk for opioid-related harm due to decreased drug metabolism and elimination, polypharmacy, and comorbid conditions. The ONE (Opioid and Naloxone Education) Program is a pharmacy-based opioid risk mitigation initiative that employs evidence-based patient screening to identify risk of opioid-use-disorder (OUD) and opioid overdose (OD). Based on screening results, pharmacists provide patient-specific education and interventions. Objective To compare the risk of OUD, OD, and the opioid harm reduction interventions provided to adults aged 65 and older to those under 65 recieving opioid medications. Design The screening tool used in this study is a paper-based, patient-facing instrument intended to be completed by the patient. Pharmacists recommend patients to complete the screening tool and participate when presenting an opioid prescription to be filled. However, completing the screening tool is voluntary for the patient. Setting The ONE Program invited all registered pharmacists in the state to participate in a free three-hour continuing education (CE) program, offered live or online. The training consisted of education including but not limited to risks associated with opioids and accidental overdose, the role of naloxone, and the use and interpretation of the opioid risk screening tool. The program began in 2018 in North Dakota and now spans over 75 community pharmacies across the state. Methods Patient demographics, opioid risk screening results, and pharmacist-delivered interventions were analyzed from 2022 to 2023. Statistical analysis and age stratification were conducted on 15,025 screenings to evaluate OUD risk, OD risk, and delivered interventions. The North Dakota State University Institutional Review Board approved the methods and research design of this study (IRB0003838). Results Patients aged 65 and older had a 36% higher risk of OD, while those under 65 had a 51% higher risk of developing OUD. The older age group received a statistically significant higher proportion of naloxone education and dispensed naloxone from the pharmacy. Concurrent use of benzodiazepines and muscle-relaxants was significantly higher in the younger age group; however, the 65 and older age group reported taking multiple opioids nearly twice as frequently as those under 65. Conclusion A comparison of opioid use, opioid risk stratification, and interventions for patients under 65 and 65 and older showed statistically significant findings. Community pharmacy-based opioid risk screening offers an innovative approach to identifying high-risk patients and delivering tailored interventions directed to opioid-harm reduction.