Fentanyl Test Strips, Point-of-Care Testing, Injectable Promethazine on House of Delegates Agenda at June Meeting

The ASHP House of Delegates (HOD) will consider some of 2023’s pressing issues in pharmacy at this year’s Summer Meetings & Exhibition in Baltimore.

Issues expected to generate in-depth discussion include over-the-counter availability of oral contraceptives and pharmacist prescribing authority for antiretroviral therapy for the prevention of HIV/AIDS, said Melanie Dodd, chair of the HOD.

“I am looking forward to being able to facilitate our delegates’ discussions, listening to each of their perspectives,” Dodd said. “I am also very excited to be able to acknowledge and celebrate all of our ASHP delegates and leaders who have contributed to our 75-year history.”

Delegates are scheduled to review policy recommendations from the Council on Pharmacy Practice, the Council on Therapeutics, the Council on Education and Workforce Development, and the Section of Pharmacy Educators. Below are a few of the topics delegates will consider.

Availability and Use of Fentanyl Test Strips

The test strips check for the presence of fentanyl, a synthetic opioid that in 2021 was responsible for more than two-thirds of drug overdose deaths in the United States over a 12-month period. More than half the states have laws declassifying fentanyl test strips (FTS) as drug paraphernalia. The Council on Therapeutics recommends ASHP adopt a policy that supports the widespread availability of FTS as part of a critical harm reduction strategy and advocates for legislation declassifying FTS as drug paraphernalia. No other pharmacy organization has a policy supporting the use of FTS.

Removal of Injectable Promethazine from Hospital Formularies

This is the second time the recommendation, which would replace a 2018 policy, comes before delegates. The recommendation calls for the removal of injectable promethazine from hospital formularies and encourages the Food and Drug Administration (FDA) to review patient safety data and consider withdrawing the drug from the market. Such a policy would put ASHP in line with the Institute for Safe Medication Practices, which has called for eliminating injectable promethazine — which can cause tissue damage and necrosis — from hospitals. At its November virtual meeting, the HOD lacked the votes — it needed an 85% supermajority — to approve the new policy.

Over-the-Counter (OTC) Availability of Oral Contraceptives

This recommendation updates a 2014 policy by saying that OTC contraceptives should be available without age restrictions under conditions that promote safe use, including the availability of pharmacist consultation. The proposed policy urges the development and use of clinical decision-making tools to facilitate pharmacist consultation. It also encourages the FDA to require manufacturers to include all patients, including adolescents, in studies to determine the safety and effectiveness of OTC oral contraceptives.

Emergency Medical Kits

A recent social media campaign highlighted the lack of standardization in emergency medical kits during an in-flight medical emergency. Airline flight supplies, for example, are not required to stock naloxone for reversing opioid overdoses. The Council on Pharmacy Practice recommends a new policy that advocates for including pharmacist expertise on decisions about stocking and maintaining medications in emergency kits.

Pharmacoequity

Pharmacoequity means ensuring that all people have access to the highest quality medications to manage their health needs. Barriers to pharmacoequity include insufficient prescription drug coverage and provider biases. ASHP has several existing policies related to this issue, such as the 2020 Preserving Patient Access to Pharmacy Services by Medically Underserved Populations. But the Council on Pharmacy Practice decided there was a need to address pharmacoequity on its own. The recommended policy calls for recognizing the impact of social determinants on health and advocating for such proposals as drug pricing structures that promote pharmacoequity.

Pharmacy Prescribing Authority for Antiretroviral Therapy for the Prevention of HIV/AIDS

Many patients, particularly people of color, face barriers to access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV infection prevention. One problem is that many states do not give pharmacists the independent authority to order and initiate PrEP and PEP therapies. The Council on Therapeutics recommends a policy advocating for legislation and regulations that expand pharmacist scope of practice to include initiation of the therapies. The policy also calls for zero cost-sharing for patients.

Point-of-Care Testing and Treatment

The Council on Therapeutics recommendation broadens a 2022 policy on the pharmacist’s role in respiratory pathogen testing to include expanding the pharmacy workforce’s role in general point-of-care testing (POCT). POCT is laboratory testing that takes place at or near the site where the patient is located. Such testing can be used for a variety of conditions, including influenza, strep throat, hypertension, congestive heart failure and stroke. State legislation regarding pharmacist-managed POCT varies widely. The Council recommends in the proposed policy to promote training of the pharmacy workforce to manage POCT and related patient care services.