Like retail pharmacists, hospital pharmacists are being held accountable for opioid use in their facilities.
When it comes to preventing opioid abuse and misuse, hospital pharmacists are under the same pressures as those in the community setting. Both groups have the legal duty to ensure that prescriptions for controlled substances are for legitimate medical needs, and both are required to have procedures in place to minimize the risk of employee theft or diversion, according to a report published online in the American Journal of Health-System Pharmacy.
One area where it is important for pharmacists to keep current is that of labeling standards for opioids, as they are subject to change. For example, in September 2013, FDA issued new labeling for long-acting and extended-release opioids, requiring that these drugs be used only for severe pain by patients needing continuous daily treatment over the long term and for whom alternative treatments are not adequate.
In addition, “Health-system pharmacists must remain vigilant for questionable orders of prescriptions. As individuals who abuse drugs find it more difficult to obtain opioids from retail pharmacies, they may turn to emergency departments and outpatient pharmacies to obtain these medications,” wrote Daniel J. Cobaugh, PharmD, vice president of ASHP Research and Education Foundation, Bethesda, Md., and his colleagues in their article, “The opioid abuse and misuse epidemic: Implications for pharmacists in hospitals and health systems,” scheduled for publication in the September 15 issue.
Record-keeping requirements are extremely important in hospital pharmacies, and policies should be in place to ensure that orders and prescriptions are complete and accurate. Pharmacists working in the hospital setting should also be aware of the restrictions on opioids for maintenance or detoxification of drug-addicted patients.
“The basic rule is that only an opioid treatment program registered with DEA is permitted to use an opioid drug to maintain or detoxify an opioid-addicted individual,” the authors wrote. “However, hospital staff is permitted to provide opioid maintenance or detoxification therapy to a patient as an incidental adjunct to medical or surgical treatment of conditions other than addiction, thereby allowing a hospitalized addicted person to avoid the risk of withdrawal while being treated for some other condition.
In addition, hospital staff can provide opioids to an addicted patient with intractable pain, such as the case of a cancer patient who has become addicted to these medications.
Policies and procedures should be in place to prevent or minimize the risk of hospital staff theft or diversion of opioids. The risk of diversion is particularly problematic in the case of prefilled syringes or single-use vials of controlled substances when the physician orders a smaller dose than the syringe or vial contains.
“A nurse could carry an empty sterile vial in a pocket and, instead of destroying excess drug, inject it into the vial; this pattern could be repeated several times throughout the shift,” diverting a large amount of a controlled substance that could be hard to trace, Cobaugh and colleagues wrote.
Directors of pharmacy should be aware of these risks and institute policies and procedures to minimize the potential of employee theft or diversion of these drugs, the authors said.
Overall, pharmacists working within a health system can play a vital role in identifying opioid toxicity and in preventing inappropriate prescribing of these controlled substances and diversion of these painkillers.