Pharmacists Bring Opioid Care to the Community

Damian Peterson logs 20,000 steps a day to care for San Francisco residents with opioid use disorders.

A psychiatric clinical pharmacist with the San Francisco Department of Public Health’s behavioral health services division, Peterson spends four days a week visiting residents of permanent supportive housing units, and another day offering behavioral health and substance use treatment at a walk-in urgent care clinic that primarily serves unhoused individuals.

Providing care at home
Through a collaborative practice agreement, Peterson brings care to patients at their homes by performing initial assessments, gathering their medical histories, and helping develop treatment plans, including prescribing medications for opioid use disorder (MOUD), such as buprenorphine.

Peterson, who manages 68 clients, can also refer them to care for other needs. “These are clients that I see every week, over an extended period of time, so I get to know them really well,” Peterson said. “Seeing them accomplish their goals over time…is really fulfilling. The service is designed to reach people who are struggling to access traditional healthcare. These are people who never go to the doctor, don’t make it into clinics, and a lot of them don’t have that many interactions with the healthcare system. They’re very isolated at times.”

One of his recent success stories was a former athlete and successful entrepreneur, now in his 50s, who struggled with heroin and speed use for nearly three decades and became estranged from his family. Through motivational interviewing and relationship-building, Peterson says he helped encourage the man to start substance use treatment, and helped get him on a long-acting injectable. He also had several phone calls with the man’s daughter to involve her in treatment plans. The client eventually planned to visit his daughter in Seattle over the summer.

Some of Peterson’s clients have tried buprenorphine before but had bad experiences, so he spends time building trust, educating them about treatment options like microdoses of buprenorphine, and “empowering them with enough knowledge to feel comfortable enough to give it a shot.”

Training paramedics to provide MOUD
Beyond his work as an emergency medicine clinical pharmacist, Curtis Geier spends time teaching local paramedics how to administer buprenorphine and naloxone to patients with opioid use disorder.

Geier, an ASHP member who works at Zuckerberg San Francisco General Hospital, said it was a natural fit to work with the local EMS agency overseeing ambulance companies in the city as they were based at his hospital. Initially, he consulted for the agency and did some teaching for community paramedics. Eventually, they established a formal role for him as a pharmacotherapy consultant.

“Paramedics go through their normal training in school, but that doesn’t necessarily teach them specific protocols that a county may have,” said Geier, who also is an associate clinical professor at the University of California, San Francisco.

One of the groups Geier helps is a community paramedic program — experienced paramedics who provide more in-depth care for people who frequently require medical services. He teaches them about opioid use and alcohol use disorders, as well as psychiatric conditions and basic chronic disease states like chronic obstructive pulmonary disorder.

It’s not uncommon for EMS to get a call about someone experiencing an opioid overdose or about someone who already has been given naloxone and is experiencing acute opioid withdrawal symptoms, Geier said. Paramedics he works with are trained to use the clinical opiate withdrawal scale (COWS) tool to measure symptoms, then call the base hospital, describe the scenario to a physician and get patients started on buprenorphine. Patients wanting to begin treatment for opioid use disorder also can call the local EMS and get started on buprenorphine, offering immediate access to care.

Geier said he enjoys learning from EMS personnel as well. “Their work is very undervalued,” he said. “They’re the people actually going into buildings and attempting to save people. It’s pretty amazing what they can do.”