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What a large national chain is doing to combat opioid abuse (and what other pharmacies can learn from it).
As the opioid epidemic spirals out of control, all pharmacies from independent to major chain to health-systems are starting to take steps in fighting it. A recent APhA study looked at one of those chains, Walgreens, to analyze just how effective their strategy for fighting the opioid crisis really is, and the results provide insights for pharmacists in every corner of the industry.
One goal of the APhA 2017 annual meeting was to increase awareness about pharmacists’ roles in combatting the opioid crisis. As a part of this, the APhA journal, JAPhA, put out a special issue on the topic. One article, “A nationwide pharmacy chain responds to the opioid epidemic,” quantifies the success of Walgreens’ efforts to combat opioid abuse and makes suggestions for how other chains and independent pharmacies can use these same strategies.
The study looked at three strategies: providing kiosks for the disposal of unused medications, expanding access to naloxone, and providing counseling on the risks of opioids and how to avoid overdose. These strategies include increased training for pharmacists on how to dispense naloxone, which can be dispensed without a prescription in 33 states, as well as training on specific-state policies, how to recognize an overdose and the risk factors for an overdose, how to handle an overdose, as well as an overview of the impact of overdoses in the United States.
The pharmacist counsels each patient who receives naloxone on its use. This counseling covers topics including risk factors for opioid overdose, strategies to prevent overdosing, how to recognize an overdose, how to respond to an overdose, and how to administer naloxone.
The study analyzed naloxone distribution in states between 2012 and August of 2016. In 2012, Walgreens dispensed only 18 naloxone prescriptions in 11 states and Puerto Rico. In comparison, in the first eight months of 2016, Walgreens had dispensed 10,478 naloxone prescriptions in 49 states.
By October of 2016, Walgreens had installed more than 500 medication-disposal kiosks, and the program had disposed of more than 10 tons of medication.
A major challenge that Walgreens, or any other chain in more than a few states, faced was how naloxone dispensing laws were changing in each state. Because of this lack of coherence, a large-scale roll-out of the naloxone strategy was difficult. The study recommends creation of national policies that would streamline the roll-out process and make uniform training possible.
The study also found challenges for individual pharmacists. In community pharmacies especially, the plan could be prohibitively time-consuming, the authors noted. In addition, there is no reimbursement plan in place for this extra time spent documenting and counseling. Developing strategies thus requires the cooperation of many organizations. The authors recommend “broad efforts” to adopt new CDC guidelines for opioid prescribing and that more organizations adopt similar opioid addiction programs.
The study concludes by saying that access to naloxone, patient education, and disposal kiosks are “key initiatives to address the opioid epidemic and reduce the increasing national burden of opioid overdose.”