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Raymond C. Love, PharmD, BCPP, FASHP, CPNP Past President

In recent years, states have increasingly amended their pharmacy practice acts to allow pharmacist administration of medication. One of the medication classes that is frequently the subject of this legislation is long acting antipsychotic injections (LAIs). 

In December of 2016, the National Alliance of State Pharmacy Associations (NASPA) and CPNP convened a national expert conference to discuss the issues involved in pharmacist medication administration and specifically administration of LAIs. The conference included representatives of various pharmacy organizations as well as the American Nurses Association, the American Psychiatric Association, the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Council for Behavioral Health, the National Association of State Mental Health Program Directors (NASMHPD) and the US Public Health Service.    

The meeting focused on critical questions that should be addressed by states as opportunities for pharmacist administration of LAIs expands. Participants discussed opportunities for pharmacists in both clinic and community settings as well as barriers to pharmacist administration. Specific topics addressed included training and continuing education, the need for pharmacy policies and procedures to govern this practice, issues regarding boards of pharmacy, documentation and the requirements for an “order to administer.” 

The participants noted that LAI administration differs from immunization. While vaccine administration usually involves a single encounter between a patient and pharmacist, LAI administration requires a series of encounters. It offers additional opportunities for patient monitoring, the need for coordination of care between the prescriber and the pharmacist and establishment of channels for pharmacist-prescriber communication. Psychiatrist and psychiatric pharmacist representatives at the meeting emphasized a more interdisciplinary team approach than that employed with immunization models. All of the attendees agreed that the pharmacist can play a vital role in increasing access to LAIs. The proceedings are summarized in a white paper published here:

In addition to the white paper, the interactions at the conference resulted in further discussions of the role of the psychiatric pharmacist and the role of pharmacists in mental health. Both SAMHSA and NASMHPD expressed an interest in further exploring these issues with CPNP. In early March, CPNP leadership was invited to meet with the SAMHSA Medical Director, Anita Everett, MD. As a follow up to this meeting, this summer, SAMHSA will be convening an invitational meeting on the pharmacist’s role in behavioral health. Additionally, several CPNP members were invited to participate in a related stakeholder conference organized by APhA on the topic of Improving Patient Access to Injectable Medications. This conference fostered national dialogue intended to advance the pharmacist's role in the provision of injectable medication administration services (MAS) and related patient care services, and to establish pharmacy as a site of care for these injections. 

CPNP has also had further discussions with industry about both LAI and naltrexone administration and is currently consulting with Florida about its new law allowing pharmacist administration of LAIs.

For many years CPNP members have championed LAI management and developed pioneering practices that include LAI administration. Your expertise and experience are now informing the rest of the profession and leaders in behavioral health.

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