Pharmacists cannot solve the drug abuse problem, but they can refrain from abetting drug-seekers - and give chronic-pain patients the support they deserve.
Paul NguyenIt is estimated that more than 15 million U.S. citizens abuse prescription drugs. Only 4.6% of the world’s population lives in this country, yet 80% of the world’s opiate consumption takes place here. The United States is responsible for 99% of the world’s consumption of hydrocodone, the most commonly prescribed opioid. According to the Centers for Disease Control and Prevention, overdose deaths caused by pain medications have increased 415% in U.S. women and 265% in U.S. men since 1999. Drug abuse is now considered epidemic.
According to the National Institute on Drug Abuse, “Between 1991 and 2010, prescriptions for stimulants increased from 5 million to nearly 45 million, and for opioid analgesics, from about 75.5 million to 209.5 million.” This suggests that discretion needs to be used when scheduled prescriptions are filled and dispensed.
In addition to overprescribing, prescription drug abuse is often linked to easy access to the patient’s medications by family and friends. In fact, 71% of misused pain relief medications are obtained from family or friends. Young people’s access to scheduled drugs has resulted in more deaths than those from cocaine, methamphetamine, and heroin combined.
Adding to the issue of accessibility are the rising numbers of “pill mills,” at which corrupt doctors prescribe large amounts of controlled medications for cash.
The problem is complicated by the fact that as our population ages, many people do suffer severely from chronic arthritic pain and forms of cancer that require pain management. Consequently, increasing numbers of prescriptions for pain medications have been written. Pain is often difficult to assess, and concern about undertreated pain may be behind some prescriptions. Also, many patients are unaware of drug safety issues and assume that because a doctor prescribed it, a drug must be safe.
Use of Prescription Drug Monitoring Programs (PDMPs) should be expanded. PDMPs enable pharmacists and physicians to determine whether a particular patient is going to several doctors and pharmacies to obtain the same drug.
Pharmacists are required to call the prescribing doctor for clarification and can refuse to dispense a medication if they feel the prescription is not legitimate. The National Board of Pharmacy and the DEA encourage pharmacists to consider the following before dispensing a scheduled medication:
· Irregularities on the face of the prescription
· Combinations of drugs such as oxycodone, alprazolam, and carisoprodol
· Prescriptions that are written outside the prescriber’s medical specialty
· Prescriptions for medications with no logical connection to diagnosis and treatment
· Initial prescriptions written for stronger opiates ( e.g., OxyContin 80 mg)
· The same combinations of drugs prescribed for multiple patients
· Prescriptions written for potentially duplicative drugs
· Prescriptions written for an unusually large quantity of drugs
· Age or presentation of patient (e.g., youthful patients seeking chronic pain medications)
· Requests for early refills of narcotic prescriptions
· Long distances between the patient’s home and the prescriber’s office or pharmacy
· Multiple patients living at the same address
· Cash payments for scheduled drugs
During consultations with patients, pharmacists should advise them about the safety and potential dangers of prescription drugs. To discourage access by others, proper storage of scheduled drugs and disposal of unused medications should be promoted.
The next National Take Back of Drugs is scheduled for April 26, 2014. The DEA will soon be releasing new guidelines for disposal of outdated and unused medications, and starting April 1 it will offer a locator (http://bit.ly/takebackDEA) for drug take-back sites across the country.
Pharmacists cannot solve the drug abuse problem, but we have a responsibility to ensure that only legitimate prescriptions are filled and dispensed.
1. Avila J, Murray M. “Prescription painkiller use at record high for Americans,” ABC News Network, April 20, 2011. http://bit.ly/rxrecord. Accessed February 6, 2014.
2. CDC, Injury Prevention and Control, Policy impact: Prescription painkiller overdoses. http://bit.ly/CDCrxOD. Accessed February 6, 2014.
3. Foundation for a Drug-Free World. The truth about prescription drug abuse: International statistics. http://bit.ly/RxODstats. Accessed February 6, 2014.
4. NIH, National Institute of Drug Abuse, Topics in brief: Prescription drug abuse. http://bit.ly/NIHnida. Accessed February 6, 2014.
5. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health 2010. http://www.samhsa.gov/data/NSDUH.aspx. Accessed February 6, 2014.
Paul Nguyenis a PharmD candidate at the College of Pharmacy, Touro University, Vallejo, Calif. E-mail him at email@example.com.