Some prescribers feel it is their duty to provide medications to patients for pain control, but it’s the pharmacist’s responsibility to screen the appropriateness of these prescriptions, according to David Brushwood, BSPharm, JD, Professor Emeritus, University of Florida College of Pharmacy.
Pharmacists should screen individual prescriptions instead of specific prescribers, specific patients, or specific drug products. “Pharmacists should not use generalizations like refusing to fill prescriptions from a certain physician or for a certain patient, or not filling prescriptions for a specific drug product (e.g., oxycodone),” Brushwood said. “Instead, pharmacists should focus on each prescription, and look at the entire context of it and how patient, prescriber, and medication-related factors all play a role in determining if it is appropriate or not.”
Brushwood developed a VIGIL screening process that he recommends for use by pharmacists when filling opioid prescriptions. Within the VIGIL process, providers are given a list of factors that may be associated with an increased risk of abuse or diversion, along with a list that may reduce this risk. Once all the factors are considered, patients are rated as being from low to high risk for abuse or diversion. The VIGIL process also includes a verification of the patient’s identification and patient-specific responsibilities.
Step I: Verifying the prescription (receiving the prescription)
Step II: Risk stratification (prescription processing)
Step III: Clarification of patient responsibility (prescription delivery)
“Prescription drug monitoring programs (PDMPs) are one of many tools that may be useful when screening prescriptions,” Brushwood said. He noted that PDMPs are a starting point and not an ending point when evaluating the appropriateness of prescriptions for controlled substances. “If a report comes back clean, pharmacists may set aside concerns—when in reality, the report should only be one of many factors that are taken into consideration,” he added.
Pharmacist–patient agreements (also known as contracts) and urine drug testing also “may be useful as they clearly lay out both the pharmacist and patient responsibilities,” said Brushwood. Urine drug testing is more of a prescriber strategy because it may be difficult for pharmacists to obtain and/or monitor these results.