How Do Pharmacies Serve as Part of the Opioid Abuse Solution?
Pharmacies have a long-standing and ongoing commitment to serving as part of the opioid abuse solution, while caring for those in pain. Their work includes:
- programs to help assure they and their employees comply with regulations
- offering and supporting drug-disposal options, to help keep opioids out of the wrong hands
- education for patients, communities, parents and teens
- in-store security
- helping to make available naloxone – the overdose antidote
- working to stop illegal online drug-sellers and rogue clinics
- diverse and creative charitable programs
- and more.
In 2019, NACDS released a video message that affirms this commitment, and that recognizes the dedication of pharmacists on the front lines of healthcare delivery.
A Chain Pharmacy Community Engagement Report compiled by the National Association of Chain Drug Stores (NACDS) found that opioid abuse prevention was one of the top three areas of focus reported by NACDS members.
What is the Pharmacist’s “Corresponding Responsibility” to Help Prevent Opioid Abuse?
In an op-ed published on Medium, NACDS President & CEO Steven C. Anderson, IOM, CAE, described pharmacists’ “corresponding responsibility” this way: “There is a moment of truth when a patient walks into the pharmacy to fill an opioid prescription. The pharmacist makes a professional decision as to whether the prescriber wrote the prescription for a legitimate medical purpose, or whether something else is going on. At that moment of truth, two worlds collide: the pharmacist’s commitment to patient care, and the pharmacist’s role as part of the solution to drug abuse and addiction.”
Just as doctors are required to be responsible when they prescribe controlled substances, Drug Enforcement Administration (DEA) regulations require of pharmacists a “corresponding responsibility.” As a result, before dispensing opioids or other controlled substances a pharmacist must exercise professional judgment to investigate and resolve any “red flags” which suggest that the prescription was not written for a legitimate medical purpose in the usual course of professional practice. Just as doctors participate in extensive education and training regarding the appropriate use of controlled substances, pharmacists engage in extensive training to empower their compliance with this “corresponding responsibility.” In fact, one of the resources used to help pharmacists determine the legitimacy of a prescription was developed jointly by NACDS, the American Medical Association, and the National Association of Boards of Pharmacy.
What Can the Government Do to Advance Opioid Abuse Solutions?
NACDS works for opioid abuse solutions at the federal and state levels of government, and in the legislative and executive branches of government. NACDS’ policy recommendations include:
- legislating a seven-day supply limit for initial opioid prescriptions issued for acute, or temporary, pain (without limiting the treatment of chronic, or ongoing, pain or that related to cancer, illness, or end-of-life)
- legislating a requirement that all prescriptions be issued electronically, with limited exceptions
- creating a nationwide prescription drug monitoring program (PDMP) through collaboration, while at the same time improving PDMPs to foster the goal of a nationwide database
- enabling pharmacies to provide prescription disposal solutions that meet patients’ needs
- reforming health plan design to help identify and treat substance abuse disorders
- improving coverage for pain-management treatments other than opioids
- enabling access to naloxone – the overdose antidote – when opioids are prescribed.
New opioid law
NACDS’ policy recommendations for opioid abuse solutions have met with success at the federal and state levels, though more work remains. The SUPPORT for Patients and Communities Act, enacted in 2018, includes important aspects of NACDS’ recommendations. For example, the new law requires electronic prescribing of controlled substances under Medicare Part D. Beyond the action taken in the federal law, half of the states now have enacted an NACDS-backed electronic prescribing requirement. In addition, 33 states have moved forward with a supply limit on a patient’s first opioid prescription for acute, or temporary, pain.
What about Illegal Fentanyl?
NACDS remains committed to serving as part of the opioid abuse solution. Most of the crisis, however, does not involve legally available opioids. Illegally manufactured and trafficked fentanyl increasingly is recognized as a significant part of the problem. In fact, a national survey fielded by Morning Consult in January 2019 and commissioned by NACDS found that one-in-three voters say illegal fentanyl contributes most to the opioid-abuse epidemic. Four-in-ten say illegal fentanyl and legally-acquired opioids contribute similarly.