George Budd: Pioneering pharmacist first to complete fellowship in addiction medicine

George Budd is a pioneer: the first pharmacist to complete a fellowship in addiction medicine at the B.C. Centre on Substance Use. No formal program existed for pharmacists, so he designed a program tailored to his interests. His experience is being used as the centre officially launches a pharmacy-based fellowship this month. Budd became a practicing pharmacist after graduating from Cairo University in 1992, but his interest in addiction medicine sparked in 2005, when he attended a Canadian Society of Addiction medicine conference. “I had very little knowledge of addiction at that point,” he told Pharmacy Practice + Business. “Prior to that, I was a dispensing pharmacist, so I had dispensed methadone, but back then there was no requirement for pharmacists to have any training in addiction medicine. Methadone was just dispensed like any other medication.” Budd began work for the B.C. College of Pharmacists where his expertise in addiction medicine grew, including completing a related rotation while pursuing his PharmD. He worked in collaboration with the College of Nurses and Midwives of B.C. and the College of Physicians and Surgeons of B.C. on numerous decisions to curb the opioid crisis, including contributing to the work required to allow nurse practitioners to prescribe opioid agonist treatment. Until recently, he was the only non-physician on the board of the Canadian Society for Addiction Medicine. All his work was from the policy and administrative side, so in 2018, he approached the medical director of fellowship at the B.C. Centre on Substance Use to see if he could pursue a fellowship. “George Budd was part of the initial pilot proof-of-concept phase of our pharmacy stream which was instrumental in building a case with our community partners to formally expand this stream of the fellowship program,” said Mona Kwong, pharmacy consultant and director of the B.C. Centre on Substance Use’s pharmacy fellowship program. Read: Pharmacists in primary care network program starts in B.C. Budd set his own rotations, mirroring the other disciplines for how many hours for clinical work and research was needed. He said that he had to use all his years of connections and networking skills to secure rotations with physicians. He worked in hospitals and primary care clinics in B.C. “When I did the fellowship, it was all under medicine. I did not do any pharmacy rotations,” he said. “What I was trying to achieve was a true and effective collaboration between disciplines,” he said. “We’ve always spoken about how the best outcome for patients would be if different disciplines collaborate for that patient, but I had never done that and I had never seen that,” he said. If it was interdisciplinary collaboration he sought, he found it. Budd was in the fellowship with nurse practitioners, physicians, social workers and others. “I got a chance to see how they do it from their perspective, and how a pharmacist can come in with our specialized knowledge and really improve the patient’s health outcome,” he said. One of the many rotations was at the Royal Columbian Hospital with an addiction medicine specialist. “I saw how a physician can see the patient and how a pharmacist can have an input,” he said. He looked for areas where pharmacists can contribute to addiction care. For example, a pharmacist could help by conducting a drug use history with a new patient, he said. They could also help with a patient’s assessment of self, talking to patients about their therapeutic choices or monitoring treatment. “I was also trained on motivational interviewing; how do you get the patient to commit to the treatment, how do you identify potentials for change, how do you make a patient understand where they are on a scale of readiness to change,” he said. He said that pharmacists can collect information, discuss it with the prescriber, and then bring it back to the patient. “Pharmacists can definitely bridge a lot of those gaps,” he said. He paid out of pocket to participate in the year-long fellowship. “I really believe in knowledge and education,” he explained. Read: Ian Stewart on the need for mentoring and its many benefits Budd believes that the healthcare system could harness the potential of pharmacists when it comes to addiction medicine. Community pharmacists not only provide addiction care, but can also monitor for patients crossing over into problematic use of substances, he said. They can watch for unnecessary medications, and work to deprescribe medications that can be addictive, such as benzodiazepines. They can work with prescribers and steer the patient into better choices for treatment, he noted. “I do believe that pharmacists are underutilized in the system. A lot of what we do in administrative,” he said “The clinical part and the communication services that a pharmacist can provide are still behind—pharmacists could do a lot more.” Budd’s experience has led to the inaugural year of the Shoppers Drug Mart Addiction Pharmacy Fellowship. The new program aims to “build both patient care and multidisciplinary opportunities for the fellows in addictions and substance use care,” Kwong said. “This fellowship recognizes the critical role pharmacists play in the substance use continuum of care, preparing pharmacists to provide the latest in evidence-based care and better understand their role within the substance use system of care—ultimately to improve patient wellbeing,” Kwong said. Rotations will include time with a physician at a First Nations community, with peer navigators in various non-profit sectors, teaching within university courses on addictions care; and time with health authority rapid access addiction consult teams, Kwong said. Read: ‘Benzo-dope’ may be replacing fentanyl: Dangerous substance turning up in unregulated opioids However, to encourage pharmacists to study and participate in addiction medicine, proper remuneration is required. For example, in the U.S., physicians’ offices can bill for services that pharmacists provide. Budd said that a patient could get a more holistic service if a pharmacist was involved. It would also help if pharmacists had broader access to health records, such as records of investigative work and blood test results, he said. Those who take the fellowship may use their knowledge in patient care or through teaching, mentoring or conducting research. Budd is currently a research associate with the Mental Health and Substance Use unit at Vancouver General Hospital. “My work is focused on clinical research and the development of new protocols for the treatment for opioid use disorder,” he said. He’s not providing patient care because pharmacists working in a hospital pharmacy must have completed a post-graduate residency, and the fellowship is not currently recognized as equivalent to a residency. Applications are now open for the 2022-2023 year. Pharmacists with at least two years of experience and who are eligible for licensure as a full pharmacist in good standing through the College of Pharmacists of British Columbia are welcome to apply. Read: Fifty pharmacists to join B.C. primary care networks in 2021

George Budd: Pioneering pharmacist first to complete fellowship in addiction medicine

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