By: Amanda Winslow, PharmD, BCPS
The opioid crisis has created a distinct challenge for pharmacists everywhere. As the gatekeepers for medications, they must balance between ensuring patients get the relief they need while simultaneously protecting the public from drug diversion. Pharmacists are uniquely suited to assist in this crisis as they are on the front lines of healthcare and see each prescription before it is filled.
The following are 3 major responsibilities pharmacists have in the opioid crisis:
1. Fill prescriptions with care
Opioid prescriptions require more than just a simple check for right patient, right drug, and right dose. Looking at overall prescribing practices of physicians is of great importance here. Prescriptions should be individualized to patients’ size, age, condition, and previous exposure to opioids. A young patient that just underwent surgery should have a different prescription than an older patient with chronic pain. Being familiar with local prescribers can also aid in identifying any drastic changes from their usual habits, which could signify forgery. When in doubt, a pharmacist must trust their intuition and rely on their training. If it looks atypical, the best practice is to call the prescriber to verify. Most states also have a prescription drug monitoring program (PDMP) that can be used to check a patient’s fill history at other pharmacies. With updates in real time, the PDMP can reveal if patients are filling multiple opioid prescriptions from different doctors or at different pharmacies, which is a red flag for drug abuse, misuse, or drug dealing.
2. Evaluate patients’ need for naloxone
Many states now allow pharmacists to dispense naloxone without a prescription, either through a protocol or a standing order. When an opioid prescription is filled, each patient’s need for naloxone should be evaluated. The necessity can be stratified based on dose, quantity, fill history, and concomitant use of other sedating medications, such as benzodiazepines or muscle relaxers. A patient with a prescription for a high quantity of any opioid or a high potency opioid should be offered naloxone. Educating the patients on signs and symptoms of an overdose as well as the proper storage and administration of naloxone is crucial; the medication will serve no purpose if the patient does not understand how and when to utilize it.
3. Educate patients on safe medication handling
Reinforcing basic medication handling, such as keeping medications out of reach of children, yields a large impact. Remind patients that these medications can be particularly dangerous and recommend keeping them in a locked cabinet. Many opioid prescriptions are for “as needed” use, leaving some medication unused. Instructing patients on how to properly dispose of any unused medications reduces the amount of medication that can be diverted into society. Permanent drug takeback sites can be found on the DEA website. In addition, there are drug mail-back programs and in-person drug takeback events in major cities.
Filling opioids has become commonplace in every pharmacy, making it easy to forget how dangerous they truly are. These tips may seem rudimentary at first, but it is important to remember that the public leans on pharmacists for their expertise. Each time an opioid prescription crosses the workstation, a pharmacist should consider the oath they took, “I will consider the welfare of humanity and relief of suffering my primary concerns”, and guarantee a thoughtful review of the prescription with appropriate counseling.