Mary Lynn McPherson
APhA member Mary Lynn (“Lynn”) McPherson, PharmD, MA, MDE, BCPS, CPE, is professor and executive director of advanced postgraduate education in palliative care at the University of Maryland School of Pharmacy in Baltimore.
Her daughter, APhA member Alexandra (“Alex”) McPherson, PharmD, MPH, is completing a postgraduate year 2 residency in pain management and palliative care at the University of Maryland School of Pharmacy under the direction of Kathryn Walker, PharmD, BCPS, CPE.
What are your biggest takeaways about opioids?
Lynn: “My practice is in hospice and palliative care, and I’ve worked for many, many years in a primary care practice, providing care to chronic noncancer pain patients.
“Indisputably, we all need to recognize the horrendous impact of the opioid misuse and abuse epidemic, and the opioid-induced death rate, and we all share responsibility in minimizing risk of this happening. But I am equally concerned about the response practitioners have had—primarily to CDC’s actions—as much as the statistics themselves. It’s like we’ve all turned into a bunch of cavemen running around, shaking our clubs, and shouting ‘opioids bad.’
“Opioids CAN be bad, but there are a lot of medications that we don’t use without serious consideration [such as warfarin and chemotherapy]. I am now hearing from patients pretty much on a daily basis about how their doctor ‘fired’ them because they won’t write prescriptions for opioids any longer. Many primary care practitioners have simply said, ‘You need to see a pain specialist.’ Unfortunately, there just AREN’T enough pain specialists in the United States to deal with the chronic pain problem we have.
“All health care providers need to use common sense and take a cautious, fair, balanced approach to pain management.”
Alex: “I have seen hesitancy on the part of the prescriber and pharmacist in the community. When it comes to the opioid epidemic, much of the focus has been on misuse and abuse, so we’re not really thinking about the impact it’s having on legitimate pain patients.
“One area where we can be helpful is in conducting a thorough pain assessment. Taking our time to interview the patient can be incredibly helpful, especially in identifying pain etiologies that are less opioid-responsive (e.g., tension headache, fibromyalgia, and much of low back pain) and in recommending nonpharmacologic interventions (e.g., massage, physical therapy) that we don’t often think of—[even as] more and more data are emerging on the benefit of including these alternate therapies.”
What is the role of the pharmacist in pain management?
Lynn: “A lot of patients come to the pharmacist, as one of the most easily accessed health care providers, in search of an answer for their pain. We may recommend a nonprescription medication, or even a nondrug intervention. We can recommend community resources such as pain support groups, or pain specialists in the community.
“Pharmacists do have a ‘corresponding responsibility’ to assure appropriate outcomes in drug therapy, including pain management. Community pharmacists can keep an eye on appropriate quantities of opioids prescribed. For example, there is nothing a dentist is going to do to you that warrants 90 Vicodin. On the other hand, 3 days’ worth of oxycodone/acetaminophen may NOT be enough after major surgery, so the pharmacist can advocate for the patient.
“Pharmacists need to be mindful of the role of coanalgesics in chronic noncancer pain, which very commonly has a neuropathic component. The patient will likely get benefit from an antidepressant or anticonvulsant, allowing dose reduction in opioid therapy. Pharmacists can keep an eye out for worrisome drug combinations, such as opioids plus benzodiazepines, and bring this to the attention of the prescriber, particularly if more than one is involved in writing the prescriptions.
“Ask patients the important goal-setting question: ‘What would you like to be able to do that you can’t do now because of the pain?’—and then follow that up when the patient returns to the pharmacy.”
Why are you an APhA member?
Lynn: “Even though pharmacists tend to be an outspoken bunch, I think we need one voice—one strong voice, made of many members, that can champion the role of the pharmacist in legislative issues, establishment of treatment guidelines, and just moving the profession forward as a whole.”
Alex: “APhA was the very first pharmacy organization I was exposed to in pharmacy school. What drew me to APhA were the advocacy initiatives for pharmacy as a profession and the strong efforts taken to promote provider status. There are countless networking opportunities locally and nationally. And the publications (e.g., Pharmacy Today and JAPhA) are great!”
What is your biggest lesson learned about career growth and leadership?
Lynn: “My motto is ‘seize the teachable moment’—without becoming obnoxious and overdoing it, of course! Pharmacists are awesome teachers: of each other, of patients and families, of prescribers and other health care providers, of payers, of lawmakers. We are the drug experts, and we need to keep our eye on that ball and elevate and support each other and the whole profession.”
Alex: “Don’t just rely on other people to do the work, get involved! If we want to be recognized as health care providers, we must actively advocate for our profession. Educate your health care colleagues, patients, and communities regarding the wide range of services that pharmacists can provide. Pharmacists are the most accessible health care provider, and there is enormous opportunity there. By seizing opportunities for networking and mentorship, we can learn a great deal from one another. It’s important to get involved, and APhA is a great way of doing that.”
Lynn: “Keep fighting the good fight—both for pain patients and for individuals who may be headed for trouble. Those people are our patients too, and they need our help.”