Coalition Partner - Pharmacist

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What can pharmacists do amid the opioid abuse crisis?

Pharmacists may be the last line defense against opioid addiction. At Prescription Drug Awareness Conferences in Pittsburgh, the DEA called for pharmacists and soon-to-be pharmacy school graduates to tighten controls over prescription opioids that they will dispense to future patients. "You are going to be the last line of defense for us," said Gary Tuggle, the DEA special agent in charge.[1] He said that pharmacists who encounter addicts with illegitimate/forged prescriptions should take a stand and not second-guess their instincts. Pharmacists also can inform on prescribers who write opioid prescriptions too freely. Some pharmacists who attended the conference pointed out that corporate executives often pressure them to move more medications as well as encourage them to call customers at refill time to ask patients if they need anything else. Adam Dashner, a sixth-year pharmacy student at Duquesne University who attended the conference, noted that refusing to fill a prescription may provide greater value to the patient as well as the community than filling a profitable prescription.[2]

Being the last line of defense, pharmacists provide the last opportunity to reach out to patients taking opioid prescriptions. They are able to:
  • Educate the patient on:
    • General info about opioids and set realistic expectations for pain control
      • This is particularly important if the medication is going to be required long-term since the risk of addiction is higher.[3]
      • Patients should leave the pharmacy knowing the following:
        • How to take their medication
        • The side effects (including the potential for addiction and overdose)
        • How to safely store their medication
        • Where to dispose of any remaining medication once patients no longer need to take it
        • What "as needed" means on medication labels
          • Patients should know that they can take less, but not more, than the maximum amount of medication listed on the label for a 24-hour period.
    • Setting realistic expectations for pain control in order to avoid a situation where a patient takes more and more medication to curb all pain
    • The importance of not sharing prescription medications with anyone. In addition, the pharmacist can remind patients that if they don't feel better or if their pain gets worse, then they should call their doctor.
  • Recognize the signs of opioid addiction
    • A patient consistently asks for prescriptions to be filled early, with no dose escalation indicated by his or her prescription
    • Defensiveness about the early fill request or concerns about the pharmacist contacting the prescriber
    • The patient may also appear angry or combative if the pharmacist denies the early refill
    • Signs of withdrawal when seeing the patient in person
    • The patient may look disheveled, as if he or she is neglecting personal hygiene
    • "As the eyes and ears of the healthcare system, it is our [pharmacists'] responsibility to bring our observations and concerns to the attention of the prescriber," said Karen Horbowicz, PharmD, RPh, BCPS, President of the Massachusetts Pharmacists Association.[4]
  • Provide naloxone and educate about its use
  • Use a prescription drug monitoring program (PDMP)
  • Develop an armed robbery plan and make sure all pharmacy staff members know what to do - preparation will help keep everyone safer
    • Reaching out to local police prior to an emergency will allow them to assist with identifying weak points in the pharmacy's security system as well as providing contacts for nonemergency situations
    • Pharmacists should also make sure they're up-to-date on technology for their security system - high-definition cameras can be helpful both inside and outside the building
    • Pharmacists should make their presence knowns in the pharmacy by greeting customers as they enter and asking if they need help
      • "Those that have a legitimate reason for being in your pharmacy will appreciate the help and those who do not will be more likely to leave," Horbowicz said.

Also, pharmacists are generally more available than medical doctors, since retail pharmacies are practically in every town. Therefore, patients can have easier access to pharmacists to receive professional medical guidance. As the gatekeepers of prescription painkillers, pharmacists can play a key role in preventing and identifying opioid misuse and abuse.[5] "I encourage all pharmacists to get actively involved in their own communities through partnering with public and private entities like local coalitions, Dr. Horbowicz said.[6] "Only by working together will we get this problem solved."[7]


Tools & Resources

TR - Strengthen the Coalition to Reduce Opioid Abuse

Scorecard Building

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