Kaefer also lets her patients know their options so they don’t have extra medication in the house, such as by only filling part of a prescription. Laws in Virginia allow pharmacists to split the prescription, for example, dispensing five pills when 10 are prescribed and having the patient come back if more are needed.
She also tells patients how to correctly dispose of leftovers. “We know this is a huge problem if medication is left in the medicine cabinet and other people come into the house looking for it,” she says.
2. Embracing a Team-Based Approach
Teamwork is helping reduce opioid abuse in hospital and long-term care settings, says Deb Pasko, PharmD, MHA, director of medication safety and quality with ASHP. Doctors, nurses, and pharmacists work together to determine and monitor the optimal medication for patients, and respond quickly when changes are needed. “We may have a trauma patient come into the ER who has acute needs, then go to the operating room and need a high dosage, then on to intensive care,” says Pasko.
She says pharmacists should help decide what medication is indicated, the best interval, and identify any potential interactions. They can also help determine if patients should continue receiving opioids, if medication should be tapered, or if an alternative should be considered.
3. Using PDMPs
More than two dozen states now require pharmacists to check prescription drug monitoring programs (PDMPs). These electronic databases that track controlled substance prescriptions are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk, according to the CDC.
“For me the prescription monitoring program is very helpful,” says Kaefer. “If I have concerns it allows me to see the bigger picture of a patient. I can see if a patient is visiting other pharmacies. I find it very helpful that I can connect to other states.”
There have been “remarkable successes” in controlling the prescribing and dispensing of controlled substances, particularly opioids, when PDMPs are accessed, says Carmen Catizone, RPh, MS, DPh, executive director of the National Association of Boards of Pharmacy.
As more states embrace PDMPs, their potential to help curb the epidemic is growing. Promising developments in PDMPs, according to the CDC, include:
- More seamlessly integrating them into electronic health records
- Permitting physicians to delegate PDMP access to other allied health professionals in their office (physician assistants and nurse practitioners)
- Streamlining the process for providers to register with the PDMP.
While monitoring is helping decrease the abuse of prescription opioids, some industry experts fear it may be contributing to more dangerous practices among abusers. In the last few years, overdoses from illicit opioids, such as heroin and fentanyl, have skyrocketed.
“The most serious concern about [PDMP] implementation is that it could push people who are misusing prescription opioids to an illicit drug market that is flooded with ultra-potent fentanyls.” says Hill. “In my opinion, that isn’t an argument against [PDMPs] so much as an argument for expanded access to evidence-based treatment with methadone and buprenorphine.”