A line of defense against opioid abuse

With the nation in the grip of a deadly opioid epidemic, there is a desperate search for solutions — and that search often begins and ends with drug companies and doctors. This is not surprising. Big pharma and physicians are the stars of our health care system and some have engaged in practices that need to change.

But often overlooked are pharmacists, the professionals who are the last line of defense against opioid prescriptions that should never be filled.

Unlike cocaine and heroin, opioids are not smuggled across borders by drug cartels. In 2014, more than 18,000 people in the United States — including 90 in Nassau County and 96 in Suffolk County — died from overdoses from opioids and other prescription pain medications. Just about every pill in those deaths was dispensed by a pharmacist.

This puts the nation’s 295,000 pharmacists in a unique position that comes with both the special responsibility — and ability — to help bring the opioid plague under control. From their vantage point, pharmacists can spot abusive practices by patients and prescribers no one else might be able to see. They can refuse to fill dubious prescriptions. They also can educate patients on the proper use of these powerful drugs.

But today some pharmacies are not doing enough to fight this epidemic. And with the hunt for effective responses focused on drug companies and doctors, there is almost no one holding pharmacies to the highest standards when it comes to distributing opioids.

Here are five quick and efficient actions — that are not part of routine practice today — that pharmacies and the government can take to have an immediate impact on the opioid crisis:

• Pharmacists should do more to crack down on “doctor shopping,” the practice of patients getting prescriptions from multiple physicians and then filling them at multiple pharmacies. Most states have Prescription Drug Monitoring Programs, or PDMPs, databases that can tell pharmacists where and when a patient has filled prescriptions in other pharmacies in the state. These are effective at detecting abuse. In New York and elsewhere, the state should require pharmacists to check PDMPs when filling prescriptions for highly controlled substances. And the state should enforce compliance.
• Pharmacists should call the medical providers whenever they see a suspicious prescription to prevent abuse. Such calls require pharmacy diligence and an investment of time but considering the potential for saving lives, the practice is worth it.
• The federal government should require physicians to write diagnosis codes on their prescriptions for opioids and other controlled substances so that pharmacists can see that the prescriptions are appropriate for the condition being treated. Even without a federal requirement, the health care community should encourage this protocol.
• Ideally, pharmacies and law enforcement agencies should start to exchange information on drug trends and patterns of abuse. While there are legitimate medical confidentiality concerns about how this is done, such relationships could be designed to both safeguard patients’ privacy and be effective.
• Pharmacists should be better educators to ensure patients know the key facts about the drug, including dosage, potential side effects and the potential for interactions with other drugs. Often, this does not happen.

The battle against opioid abuse will be long and hard and will involve many players. But without pharmacists doing all they can, we will needlessly lose lives to addiction and death. That is something the nation simply cannot afford.

Robert M. Stutman and Arthur Kersey are former Drug Enforcement Administration agents. Stutman and Kersey are, respectively, member of the board of directors and chief compliance officer of Linden Care, a pharmacy company in Woodbury specializing in pain medication.