TV and news stories about opioid overuse and misuse seem to be increasingly common. Additionally, the number of prescriptions written for opioid medications is increasing, although the rate of successful pain treatment from them has remained unchanged. Reversing this trend will require some serious changes for everyone involved, from patients to physicians to pharmacists.
There is an increasing tendency among physicians to prescribe opioid painkillers for pain, but often opioids are prescribed too quickly, without considering other medications or fully discussing the risks of opioids. Tools like Pain Doctor’s 12-Step Checklist can help encourage discussion and thoughtfulness for both physicians and patients.
To make lasting changes where opioid overuse is concerned, however, pharmacies will have to play a big roll, as well.
The main job of any pharmacy, certainly, is to distribute medications, as well as information about how to take those medications safely and correctly. In addition to this, pharmacies can refuse to fill a prescription. In some cases, this could be because a pharmacy’s supply of certain medications is limited.
In other cases, though, a pharmacy might refuse to refill a medication because of a safety concern, such as a patient’s allergies, dangerous interactions between medications, or a prescribed dosage that is above the recommended amount. In this last situation – a prescribed dosage above the recommended amount – a pharmacist might worry that a patient is abusing or addicted to opioid painkillers.
If all the pharmacist does is turn a patient away without his or her medication, though, there are bound to be some issues. For example, for those people with a true chronic pain condition who might really need a higher dose of pain medications, having a prescription refill refused can be a serious dilemma.
Traveling, especially, can be difficult if a pharmacist refuses a prescription because it’s too soon to refill it; if this happens, ask your physician to write a prescription you can take with, or make sure that a nationwide pharmacy chain has your prescription on file.
However, if the person trying to obtain opioid medication is overusing or abusing his or her medications, he or she will find another way to get the medication. A different pharmacy, a different prescription with a different patient’s name, or an unregulated, online pharmacy can all offer other opportunities for prescription painkillers.
Many people believe that pharmacies need a system to tell if a patient has filled prescriptions for the same medication at multiple pharmacies.
Often the people who fill prescriptions at multiple pharmacies are overusing opioids. This does not, however, refer to someone who occasionally fills a prescription at a different pharmacy while traveling or for convenience on a busy day. This refers to people who go to multiple pharmacies over a relatively short amount of time so they can fill overlapping prescriptions. When this is done to obtain a larger-than-prescribed amount of medications, the practice is referred to as pharmacy shopping.
In fact, a recently published study summarized the results of an analysis of Medicaid enrollees who used opioids within a specific time period. This analysis found that people who went to four different pharmacies within a 90-day period had the highest risk of opioid overdose.
Most pharmacies aren’t too good at sharing information with each other right now, but a potential future tool is the patient review and restriction (PRR). PRRs would allow pharmacies to tell quickly whether a patient has already filled a similar prescription elsewhere, decide if the multiple prescriptions are medically needed, and, if so, restrict the patient’s ability to get more opioids.
A similar centralized prescription network, called PharmaNet, was used in British Colombia, Canada. An article at ScienceDaily.com explains how PharmaNet works, explaining:
“The PharmaNet system allows BC pharmacists to view the most recent 14 months of a patient’s medication use regardless of which physician prescribed the drugs or which pharmacy dispensed them. The system enables pharmacists to identify potentially harmful drug interactions, accidental duplications in therapy or potential prescription drug misuse.”
PharmaNet was very successful at reducing inappropriate prescription fills. There were significant reductions in inappropriate prescription refills, sometimes as much as 49%.
If pharmacies and pharmacists are able to identify individuals who overuse opioids, they can then offer resources to help patients reduce the risk of overdose.
Pharmacists should be a resource. If a pharmacist realizes that someone is dependent on opioids for pain relief, the pharmacist should be able to provide information about local addiction counselors and support groups.
Additionally, pharmacies might soon offer another resource for people who overuse or abuse opioids.
Pharmacy-based naloxone (PBN) education and kits could curb the number of opioid overdose deaths. Naloxone is a medication that reverses the effects of an opioid overdose. If administered correctly by someone who’s been taught how to use it, naloxone can prevent death in someone who has overdosed on opioids.
PBNs would allow pharmacies to distribute naloxone rescue kits at their own discretion to at-risk individuals. Usually the distribution of a kit like this would require a prescription of its own, but pharmacies in some states have been given the authority to make the decision to give out a naloxone rescue kit without a prescription. PBNs have the benefit of being useable by people who abuse illicit opioid-based drugs, as well as those who abuse prescription painkillers. So far, the program seems to be slowing the number of opioid-related deaths.
Unfortunately, none of the above programs will work against internet pharmacies. Because online pharmacies are able to disappear and reappear so easily, simple old-fashioned patient education from prescribing physicians is the best way to combat opioid overuse or abuse from internet pharmacies.
What kinds of resources does your pharmacy have in place? Have you ever asked your pharmacist for pain management tips or advice?
Image by Mike Mozart via Flickr