{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:05:48Z","timestamp":1791572748416,"version":"4.3.4"},"reference-count":38,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,11,3]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A cross-sectional study, conducted across Punjab, Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents \u2018never\u2019 or \u2018sometimes\u2019 made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse\/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p&lt;0.05). In competency evaluation, three priority areas emerged that require additional training, that is, \u2018opioid overdose management\u2019, \u2018opioid use monitoring\u2019 and \u2018therapeutic uses of opioids\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-079507","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T12:44:22Z","timestamp":1700570662000},"page":"e079507","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Are pharmacists on the front lines of the opioid epidemic? A cross-sectional study of the practices and competencies of community and hospital pharmacists in Punjab, Pakistan"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-2168","authenticated-orcid":false,"given":"Naeem","family":"Mubarak","sequence":"first","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taheer","family":"Zahid","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima Rahman","family":"Rana","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umm-E-Barirah","family":"Ijaz","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshan","family":"Shabbir","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahrukh","family":"Manzoor","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahan","family":"Khan","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minahil","family":"Arif","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Mehroz","family":"Naeem","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabba","family":"Kanwal","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasira","family":"Saif-ur-Rehman","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5572-2719","authenticated-orcid":false,"given":"Che Suraya","family":"Zin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Mahmood","sequence":"additional","affiliation":[{"name":"University of the Punjab Quaid-i-Azam Campus, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javaid","family":"Asgher","sequence":"additional","affiliation":[{"name":"Lahore Medical and Dental College, Lahore University of Biological and Applied Sciences, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-6541","authenticated-orcid":false,"given":"Mohamed Hassan","family":"Elnaem","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,21]]},"reference":[{"key":"2025121603174485000_13.11.e079507.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.socscimed.2021.114332","article-title":"Physical pain, gender, and the state of the economy in 146 nations","volume":"287","author":"Macchia","year":"2021","journal-title":"Soc Sci Med"},{"key":"2025121603174485000_13.11.e079507.2","unstructured":"Amaechi O , Human MM , Featherstone K . Pharmacologic Therapy for Acute Pain. American Family Physician, 2022."},{"key":"2025121603174485000_13.11.e079507.3","unstructured":"Anekar AA , Hendrix JM , Cascella M . WHO Analgesic Ladder. 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Study the different incidences of tramadol in different cities of Punjab. 2021;11."},{"key":"2025121603174485000_13.11.e079507.17","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s11096-020-01152-8","article-title":"Community pharmacists \u2019 preparedness to intervene with concerns around prescription opioids: findings from a nationally representative survey","volume":"43","author":"Alvin","year":"2021","journal-title":"Int J Clin Pharm"},{"key":"2025121603174485000_13.11.e079507.18","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1177\/8755122520967766","article-title":"An exploratory study of pharmacist perceptions of opioid interventions for acute pain","volume":"37","author":"Webb","year":"2021","journal-title":"J Pharm Technol"},{"key":"2025121603174485000_13.11.e079507.19","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2021.108988","article-title":"The impact of community-level prevention strategies on high-dose opioid dispensing rates: 2014-2019","volume":"227","author":"Underwood","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025121603174485000_13.11.e079507.20","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s11096-020-01060-x","article-title":"Core Competencies for Australian pharmacists when supplying prescribed opioids: a modified Delphi study","volume":"43","author":"Maher","year":"2021","journal-title":"Int J Clin Pharm"},{"key":"2025121603174485000_13.11.e079507.21","unstructured":"Sproule B . AFPC Commitment to the Joint Statement of Action to Address the Opioid Crisis in Canada. 2018."},{"key":"2025121603174485000_13.11.e079507.22","unstructured":"Punjab Pharmacy Council. 2023. Available: https:\/\/punjabpharmacycouncil.com\/index_files\/Page528.htm"},{"key":"2025121603174485000_13.11.e079507.23","unstructured":"Punjab G . Primary & Secondary Health Care Department (pp. 1\u201371), . 2023 Available: https:\/\/pshealthpunjab.gov.pk\/"},{"key":"2025121603174485000_13.11.e079507.24","doi-asserted-by":"publisher","DOI":"10.1177\/003335491412900207"},{"key":"2025121603174485000_13.11.e079507.25","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1177\/0310057X211065769","article-title":"Opioids for acute pain management in children","volume":"50","author":"Rosen","year":"2022","journal-title":"Anaesth Intensive Care"},{"key":"2025121603174485000_13.11.e079507.26","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1177\/0310057X211070003","article-title":"Opioids in acute pain: towards getting the right balance","volume":"50","author":"Pattullo","year":"2022","journal-title":"Anaesth Intensive Care"},{"key":"2025121603174485000_13.11.e079507.27","unstructured":"Hall J . Guyton and Hall: Textbook of Medical Physiology, 12th edn. Saunders, 2013: 1112."},{"key":"2025121603174485000_13.11.e079507.28","unstructured":"Brunton LL , Hilal-Dandan R , Knollmann BC . The Pharmacological Basis of Therapeutics, 13th edn. Mc Graw Hill Education, 2022. Available: https:\/\/accesspharmacy.mhmedical.com\/book.aspx?bookID=2189"},{"key":"2025121603174485000_13.11.e079507.29","doi-asserted-by":"crossref","first-page":"49","DOI":"10.21315\/eimj2019.11.2.6","article-title":"ABC of content validation and content validity index calculation","volume":"11","author":"Yusoff","year":"2019","journal-title":"EIMJ"},{"key":"2025121603174485000_13.11.e079507.30","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2021.e07031","article-title":"Illicit sale of controlled drugs at community Pharmacy\/medical stores of Punjab, Pakistan: A road to demolition of public health","volume":"7","author":"Bashir","year":"2021","journal-title":"Heliyon"},{"key":"2025121603174485000_13.11.e079507.31","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1507771"},{"key":"2025121603174485000_13.11.e079507.32","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph15122914","article-title":"Patient satisfaction with community pharmacies services: A cross-sectional survey from Punjab; Pakistan","volume":"15","author":"Aziz","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"2025121603174485000_13.11.e079507.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-08378-4","article-title":"Task sharing in an Interprofessional medication management program - a survey of general practitioners and community pharmacists","volume":"22","author":"Moecker","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2025121603174485000_13.11.e079507.34","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0216563","article-title":"Consensus among Healthcare Stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia; A Delphi study","volume":"14","author":"Mubarak","year":"2019","journal-title":"PLoS One"},{"key":"2025121603174485000_13.11.e079507.35","article-title":"Readiness of pharmacists based in Utah about pain management and opioid dispensing","volume":"7","author":"Balough","year":"2019","journal-title":"Pharmacy (Basel)"},{"key":"2025121603174485000_13.11.e079507.36","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics10101204","article-title":"How are we educating future physicians and pharmacists in Pakistan? 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