National Rx Drug Abuse Summit: Pharmacists’ role, responsibility

Meeting in Atlanta examines prescription drug abuse epidemic and methods to address it

In the United States, 52 million people older than 12 years have taken a prescription drug nonmedically in their lifetime. Prescription drug overdoses cause more deaths annually than car accidents do. Overdoses are responsible for more than a million emergency department visits every year. CDC has officially declared prescription drug abuse in the United States an epidemic.

The National Rx Drug Abuse Summit examined this epidemic, and methods to address it, during a 4-day meeting on April 6–9 at the Westin Peachtree Plaza Hotel in Atlanta. “Pharmacy track” sessions explored pharmacists’ role and responsibility in preventing prescription drug abuse and the value-added benefits they can bring to the issue.

Prescription drug culture

U.S. residents make up 5% of the world’s population, but Americans consume 75% of the world’s prescription drugs and 99% of the world’s hydrocodone.

“We are a society that doesn’t want anything to do with pain or depression or anything. Prescription drug abuse is an accepted method for curing whatever ails you in our society,” said Joe Rannazzisi, BSPharm, JD, Deputy Assistant Administrator in DEA’s Office of Diversion Control.

Several aspects of this so-called prescription drug culture may perpetuate drug abuse in the United States. Parents model unhealthy habits and attitudes toward prescription drugs for their children. Parents may give their own prescription drugs to children. Prescription bottles are left unlocked and unmonitored in most households. Few people perceive real harm in taking medications that weren’t prescribed to them.

“People think prescription medications are safe because they’re doctor prescribed,” said Kristina Clark, Executive Director of the Tennessee-based Coffee County Anti-Drug Coalition. This perception leads many people to obtain prescriptions for drugs they don’t medically require. Pharmacists have a responsibility to ensure that the prescriptions they fill are legitimate.

Pharmacists’ responsibility

DEA regulations state that pharmacists have the same responsibility as prescribers to help prevent drug abuse and diversion. They must use their professional judgment to assess whether a prescription for a controlled substance is legitimate.

“Just because the doctor wrote the prescription, doesn’t mean the pharmacist has to dispense that medicine,” said Nicole O’Kane, PharmD, Clinical Director of Acumentra Health. “It’s up to the pharmacist to make sure that the medicine is safe and appropriate and that there are no concerns about its use.”

How do pharmacists know?

O’Kane is conducting a 5-year study of the effectiveness of Oregon’s prescription drug monitoring program (PDMP) as a clinical decision tool for prescribers of controlled substances. She encourages pharmacists to use PDMPs to help assess the legitimacy of prescriptions. 

A few red flags can indicate to pharmacists that a prescription for a controlled substance might not be legitimate:

  • Many patients have the same prescription for the same combination of drugs or for identical dosing.
  • Patients are paying cash.
  • Patient refers to the drug by its street name.
  • Patient requests early refills.
  • Prescriptions are written or being filled a long distance from the patient’s home.
  • Prescription is written to treat a condition that is not the prescriber’s specialty.

Pharmacists’ role

When pharmacists have a concern about a prescription, they have a right to contact the prescriber; contact other pharmacies that have filled prescriptions for the patient; counsel the patient or ask for further information; refer the patient for addiction treatment; and refuse to fill the prescription.

“Most pharmacists report that they’ve denied at least one prescription. As more pharmacists use the PDMP, they are getting more comfortable with denying or delaying prescriptions,” O’Kane said.

As the health care system evolves, pharmacists will increasingly provide more direct patient care and education. “Patient education is at the heart of the services that pharmacists provide,” said Anne Burns, BSPharm, APhA Vice President for Professional Affairs.

Joining teams, pharmacists have the opportunity not only to counsel patients on medication use, but also to provide information directly to prescribers.

“In medical homes and other coordinated care models, pharmacists are viewed as the drug information experts and often hold small inservices or talk to other providers about what’s new in medications,” Burns said.

These evolving roles for pharmacists represent expanding opportunities to address prescription drug abuse, according to Burns. “As pharmacists, we need to be more engaged in watching, educating, and making sure that patients aren’t starting to slide into an undesirable path.”