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The Role of the Community Pharmacist in the Opioid Epidemic

Written by Melissa Nguyen PharmD'19
Published on November 16, 2017

Prior to dispensing prescription opioids, a pharmacist has the opportunity to assess the patient. This may include questioning the patient’s medical history, opioid use, and providing additional counseling with other medications. Due to the growing Opioid Epidemic, this may be warranted. Community pharmacists can provide multiple interventions that may reduce the opioid crisis, and this blog will overview the community pharmacists’ role in dispensing opioids, fraudulent prescriptions, and providing a medication that can reverse an opioid overdose.

Community pharmacists are in a position where they can identify patients that may be abusing opioids and prevent them from gaining access. Patients could ask for early refills, presenting aberrant drug-seeking behavior. Patients that display aggressiveness and anger, or signs of withdrawal, may be addicted and pharmacists should notify their prescriber about their behavior. An assessment tool called Opioid Risk Tool Assessment Instrument can be used to evaluate patients’ risk for opioid abuse. High risk patients should be monitored closely, or their therapy should be modified to reduce opioids. These patients may benefit from an opioid agreement to hold them accountable since patients will be aware of the consequences and behaviors related to opioid abuse. By being the last health-care professional in between the patient and the opioid, the pharmacist can screen for patients who are, or may be, addicted to opioids.

Pharmacists can also reduce opioid abuse by identifying fraudulent prescriptions. Fraudulent prescriptions can either be by an individual or a prescriber.  Individuals may steal a prescription pad and attempt to forge a prescription or alter an existing script. In other cases, prescribers may be part of a “pill mill” where illegal opioid prescriptions may be for sale.  The Drug Enforcement Agency has even released a guide for pharmacists on how to screen for these prescriptions and suggests reporting them to the local police. While this guide was written nearly 20 years ago, the Justice Department still takes the opioid crisis very seriously. Attorney General Jeff Sessions has formed the Opioid Fraud and Detection Unit. This pilot program will use data to identify opioid-related healthcare fraud and prosecute prescribers or pharmacies that may contribute to the opioid crisis. States are also monitoring fraudulent prescriptions using the Prescription Data Base Monitoring Program. This allows pharmacies to see how many narcotics a patient may be receiving in a certain state and can identify patients that may be “doctor shopping.” Attorney General Jeff Sessions believes that by prosecuting individuals that benefit financially from the opioid crisis, tens of thousands of lives will be saved.

While unethical pharmacists have the potential to contribute to the opioid crisis, they are capable of reversing them as well. Pharmacists are encouraged to stock naloxone, a medication that reverses opioid overdose, by PA Pharmacists Association because it is the “right thing to do.” The College of Psychiatric and Neurologic Pharmacists have even drawn up a practical guide because they can have a hand in saving lives with naloxone. Although stocking naloxone increases access for opioid abusers, their families, and caregivers, there are many obstacles that prevent this. A large deterrent is its price for consumers and pharmacies. In 2015 Dr. Rachel Levine, PA’s Physician General issued a state wide order allowing pharmacies to dispense naloxone. This Standing Order includes provisions that enable naloxone to be billed to the patient’s insurance company, decreasing its cost. By reducing naloxone’s price for consumers, improving access may increase demand. This may reassure pharmacies that patients will purchase naloxone rather than it staying on their shelves. Pharmacists are being continuously educated on the importance of naloxone in PA. Pharmacists play an essential role in reducing opioid abuse through providing naloxone.

Pharmacists are opioids’ gatekeepers and stand in between the patient and pain relief. At the counter, they can screen the patient for risk and signs of addiction. By reporting this data, pharmacists can work with prescribers to alter therapy to reduce opioid related deaths. This collaboration can reduce consequences prescribers and pharmacists now face from the Opioid Fraud and Detection Unit. Lastly, they can prevent opioid overdose through stocking naloxone. Narcan, a naloxone product, will now be available in all Walgreens pharmacies, and at CVS  in 41 states. Due to pharmacists’ availability to patients, community pharmacists play a large role in reducing abuse and deaths related to the Opioid Epidemic.

Categories:  Department of Pharmaceutical and Healthcare BusinessHealth PolicyPublic HealthMayes College of Healthcare Business and PolicyOpioidsDepartment of Health Policy and Public HealthSubstance Use Disorders Institute