About The Author
Peter A. Kreckel, RPh, practices part time in Lemont Furnace, PA.
Pennsylvania’s departments of health and human services provided written guidelines to support community pharmacists in delivering care for patients with opioid use disorder.
Growing up on the industrial edge of St. Marys, Pennsylvania, opportunities for play were limited, so the Kreckels’ large backyard became the local gathering spot. Neighborhood children flocked there for Wiffle ball and kickball games. Left field ran alongside Fred’s garden. We had a rule: If a ball landed in Fred’s garden, it counted as an automatic out.
In the early 1980s, handling opioid prescriptions required careful attention. Schedule II prescriptions needed a distinct, 1-inch red “N” stamp and were organized in special folders. Medications were categorized as Schedule II, Schedule III through V, or noncontrolled, and extra caution was given to prescriptions involving large quantities, such as 60 Percocet-5 tablets.
Everything changed in the 1990s with the introduction of oxycodone and a new philosophy around pain management: there was no longer a ceiling dose for opioids. One patient with osteosarcoma and severe pain was prescribed OxyContin 160 mg: 5 tablets in the morning and 6 in the evening—a staggering 1760 mg of oxycodone per day or 2640 morphine mg equivalents. This dosage brought the patient relief, and all parties involved—prescriber, pharmaceutical representative, insurance company—agreed it was necessary.
Pharmacists often express concerns about Drug Enforcement Administration (DEA) scrutiny regarding buprenorphine dispensing. I’ve received calls from wholesaler compliance officers questioning increased orders of buprenorphine/naloxone (Suboxone). I would explain our dispensing numbers, leading to adjustments in order thresholds. It felt as if oversight was constant, but the actual rules were unclear, much like the ever-evolving rules we created for our backyard games.
About a year ago, I attended a webinar hosted by the DEA and Pennsylvania’s departments of health and human services, focusing on reducing the stigma around dispensing buprenorphine. The presenter, representing Pennsylvania’s departments of health and human services and the DEA, emphasized that while dual therapy (buprenorphine/naloxone) is generally preferred, some patients benefit more from monotherapy. The main priority is ensuring access to buprenorphine—whether monotherapy (Subutex) or dual therapy (Suboxone)—because denying patients this medication increases the risk that they will turn to illicit drugs.
I work for a small, independent pharmacy chain with 7 stores near the West Virginia state line. West Virginia has restrictive policies regarding buprenorphine monotherapy for substance use disorder, making access nearly impossible for many patients. As a result, many West Virginia patients seek care from Pennsylvania providers for various reasons—preference, dental issues, allergy, or cost. When I asked about filling prescriptions across state lines, the panel confirmed: There are no territorial restrictions, even across states.
Several months afterward, Pennsylvania’s departments of health and human services provided us with a document from the National Association of Boards of Pharmacy. One section addressed stigma that may be present among community pharmacists and included the recommendations:
Peter A. Kreckel, RPh, practices part time in Lemont Furnace, PA.
Pennsylvania’s departments of health and human services have provided written guidelines to support community pharmacists in delivering care for patients with opioid use disorder. I trust that the DEA will align its enforcement practices regarding buprenorphine dispensing with these guidelines. I will worry less about my fellow pharmacists with these guidelines than I did when my brother Don was up to bat and hit the ball into Fred’s garden.
To read these stories and more,
Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our
about 1 month ago
Pharmacists Can Help Manage Therapies for HyperkalemiaPharmacy practice is always changing. Stay ahead of the curve with the Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips.