© 2022 MJH Life Sciences and Pharmacy Times – Pharmacy Practice News and Expert Insights. All rights reserved.
© 2022 MJH Life Sciences™ , Pharmacy Times – Pharmacy Practice News and Expert Insights. All rights reserved.
Adequate training will help them recognize signs of misuse and assist with preventive measures.
Prescription drug abuse is a huge public health concern in the United States; approximately 6% of Americans older than 12 years who are pre- scribed these medications abuse them.
Nearly 12% of these individuals are addicted to or dependent on their medications.1 These numbers have only increased over time. Most abused prescriptions are for opioids, sedatives, or stimulants. In pharmacies throughout America, systems are in place to monitor controlled substances and patients for potential abuse, such as prescription drug monitoring programs.2 Laws have been enacted to regulate medications to mitigate their abuse. An example was the Combat Methamphetamine Epidemic Act of 2005, related to OTC medications containing ephedrine and pseudoephedrine.3 Although beneficial, various laws and monitoring programs have a limited impact on the abuse of prescription drugs.
Pharmacy personnel can play a vital role in addressing prescription drug abuse, because they encounter numerous patients taking opioids and other substances of potential abuse every day. Pharmacists and pharmacy technicians provide some level of care for patients up to 10 times more frequently than primary care physicians.4 Although it is physicians who prescribe scheduled medications, pharmacists have a corresponding responsibility to ensure that the controlled drug is prescribed correctly and for a legitimate purpose. Pharmacists have helped combat prescription drug abuse for many years, including educating patients about opioids and addiction and coun- seling them on the use of naloxone. In a few states, pharmacists also have the authority to write prescriptions for and/or provide naloxone when overdose risks are present.2 Pharmacy personnel, as stated by the deputy director of the National Institute on Drug Abuse, can also prevent prescription drugs finding their way into the community by counseling patients on the proper storage and disposal of medications. One-third of individuals who misuse opioids get them from their own prescriptions. More than half get them from family and friends who have prescriptions, either through being given the pills or obtaining them via purchase or theft.3
In the community setting, technicians encounter patients even more frequently than pharmacists do. Technicians are usually the first individuals with whom patients interact when entering the pharmacy. They answer questions, have access to patients’ medication histories, and are usually the first to hear complaints.4 Because of the amount of interaction technicians have with patients, they could be significant assets for pharmacists in assisting with drug abuse prevention measures, although this has yet to be implemented widely. It is critical that technicians are educated about dealing with patients who are either misusing or even at risk of misusing prescription medications. With proper education and training, technicians can work with pharmacists to help prevent patients from falling victim to drug abuse.
Technicians trained in the use of naloxone can administer it if needed. They are often well versed in the indications of use for naloxone and can also be trained to recognize the signs and symptoms of an individual who has overdosed.4 They can make a more powerful impact on patients before a potential overdose if they have received education on topics such as screening patients who have been taking controlled substances and recognizing the signs and symptoms of an individual who is at risk of abuse. Just as pharmacists have been trained in empathy and motivational interviewing, technicians can use these same skills to talk to patients who are on multiple controlled medications.5 Technicians should also be trained in other aspects of effective communication, such as avoiding judgmental statements, repressing possible feelings of stigma toward patients, and treating patients with assertiveness and kindness.6
Being able to identify a patient’s specific behavioral or physical attitudes can lead technicians to take the right measures to ensure that a prescription is not being abused. This also enables them to better recognize red flags and warning signs for abuse of prescribed medications.7 Warning signs include patients self-adjusting their medication intake because the prescribed amount was insufficient to alleviate their condition; presenting more than 1 controlled substance prescription at the drop-off window; returning sooner than the refill date; and/or showing signs of aggression when they are not given their medications early.4 Technicians should be able to recognize these signs promptly. Pharmacists check for red flags by assessing the legitimacy of the prescription and ensuring that the purpose of taking the medication is valid and that the patient knows why they are taking the drug. Often, pharmacists must contact physicians to confirm this information, but the busy schedules of both can make it challenging to get through to each other.7 Technicians can contact prescribers when necessary and speak to patients when prescriptions are dropped off.
Technicians can also play a part in accessing and interpreting a patient’s prescription drug management profile. Pharmacists from each state have measures for keeping track of controlled-substance prescriptions, whether the prescriptions were filled in their pharmacies or at others. An example of
the standard used in California is the Controlled Substance Utilization Review and Evaluation System (CURES). This database collects information for all patients who have been prescribed any controlled substances, including patients’ name, date of birth, address, prescribing doctor, and all the pharmacies where prescriptions have been filled.8 This is especially useful when a patient has been turned away from filling the prescription at one pharmacy and attempts to get it filled at another.9 Technicians have access to similar patient information within the pharmacy’s database. Because technicians have been trained to abide by the Health Insurance Portability and Accountability Act of 1996, they should also be allowed and instructed
to access the CURES database every time a patient comes in with a prescription for a controlled substance. This allows technicians to have a better understanding of patients. Under the proper direction of a pharmacist, technicians can also double-check to make sure prescriptions are
valid or even contact a physician’s office to verify patient information.
Because of the nature of their position, technicians can play a vital role in curbing prescription drug abuse. With adequate education and training, they will know how to identify the signs of drug abuse and assist with other preventive measures. Technicians can read and learn from training manuals and guides such as those that pharmacists use. However, employers’ operational manuals can be amended to include technician-specific language. Following through with these steps to expand the role of technicians can help combat prescription drug abuse, positively affecting the lives of patients and helping pharmacists become more efficient in their daily practices.
Nedah Basravi and Hasina Jalala are PharmD candidates at Touro University California College of Pharmacy in Vallejo.
Shane P. Desselle, PhD, RPh, FAPhA, is a professor of social, behavioral pharmacy, and administrative sciences at Touro University California College of Pharmacy in Vallejo.
1. Prescription drug abuse statistics. National Center for Drug Abuse Statistics. Accessed January 3, 2022. https://drugabusestatistics.org/prescription-drug-abuse-statistics/
2. Chisholm-Burns MA, Spivey CA, Sherwin E, Wheeler J, Hohmeier K. The opioid crisis: origins, trends, policies, and the roles of pharmacists. Am J Health Syst Pharm. 2019;76(7):424-435. doi:10.1093/ajhp/zxy089
3. Compton WM, Jones CM, Stein JB, Wargo EM. Promising roles for pharmacists in addressing the opioid crisis. Res Social Adm Pharm. 2019;15(8):910-916. doi:10.1016/j.sapharm.2017.12.009
4. Geise R, Powers MF. Roles of pharmacy technicians in preventing prescription drug abuse. J Pharm Technol. 2020;36(5):211-217. doi:10.1177/8755122520939640
5. Tsuyuki RT, Beahm NP, Okada H, Al Hamarneh YN. Pharmacists as accessible primary health care providers: review of the evidence. CanadianPharm J(Ott). 2018;151(1):4-5. doi:10.1177/1715163517745517
6. Cernasev A, Desselle S, Hohmeier KC, Canedo J, Tran B, Wheeler J. Pharmacy technicians, stigma, and compassion fatigue: front-line perspectives of pharmacy and the US opioid epidemic. Int J Environ Res Public Health. 2021;18(12):6231. doi:10.3390/ijerph18126231
7. Stakeholders’ challenges and red flag warning signs related to prescribing and dispensing controlled substances. National Association of Boards of Pharmacy. Accessed January 19, 2022. https://nabp.pharmacy/wp-content/uploads/2016/07/StakeholdersChallengesandRedFlagsandWarningSignsRelatedtoPrescribingandDispensingControlledSubstances.pdf
8. Controlled Substance Utilization Review and Evaluation System. State of California -Department of Justice. Accessed January 17, 2022. https://oag.ca.gov/cures
9.Henry SG, Pugliese J, Gosdin M, Crawford AJ, Wintemute GJ. Survey of California physicians’ and pharmacists’ experience with and attitudes about CURES 2.0. University of California Davis Health. November 2017. Accessed January 15, 2022. https://health.ucdavis.edu/vprp/pdf/2017/2017.11.CURES_Survey_Report.pdf5 / 5125%