This is for our readers that practice pain management.
Pharmacists in Indiana are three times more likely to refuse to dispense a controlled substance when they use the state prescription drug monitoring program than when they don’t, results from a new survey show.
“The pharmacist is the last line of defense to check the red flags for prescription drug abuse and diversion,” said lead investigator Connor Norwood, MHA, from the Indiana University School of Medicine in Indianapolis.
“This study shows that drug histories do change pharmacists’ dispensing practices,” he told Medscape Medical News.
To find out whether Indiana’s prescription drug monitoring program, known as INSPECT, affects pharmacists’ dispensing of controlled substances, Norwood and his colleague, Eric Wright, PhD, from Georgia State University, surveyed more than 1500 pharmacists.
Norwood presented the research here at the American Public Health Association (APHA) 2015 Annual Meeting. It was previously published online Research in Social & Administrative Pharmacy.
Prescription Drug History
INSPECT tracks a patient’s drug history in Indiana, the prescribers involved, the pharmacies used, and the pharmacists who dispensed the drugs.
It is a “great” tool to supplement the pharmacist’s professional judgment when dispensing controlled substances, Norwood explained. It identifies patients who have multiple providers for prescription drugs, such as painkillers, which is an indication of “doctor shopping.”
Dispensing Controlled Substances
In November 2012, Norwood and his colleague, working in collaboration with the Indiana Professional Licensing Agency, sent an anonymous survey to 10,606 Indiana pharmacists who could dispense controlled substances.
The survey asked pharmacists about their use of INSPECT, and whether they had refused to dispense any controlled substances — such as opioids, benzodiazepines, muscle relaxants, barbiturates, sedatives, hypnotics, stimulants, anorectics, and decongestants — in the previous 12 months.
The team received 1582 responses, for a response rate of almost 15%. Mean age of the respondents was 46.9 years, 54% were female, and the mean length of practice was 20.8 years.
Overall, 8% of pharmacists reported using INSPECT for every controlled substance prescription, 78% reported using it periodically, and 4% reported never using it. The remaining 10% of respondents, who reported using INSPECT at “other time intervals” were excluded from the analysis.
And 1185 pharmacists reported refusing to dispense at least one controlled substance in the previous year.
Pharmacists who reported any use of INSPECT were more likely to have refused to dispense a controlled substance in the previous year than pharmacists who never checked the database.
Pharmacists who reported the periodic use of INSPECT were more likely to refuse to dispense a controlled substance than those who never used it (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.4 – 6.8), as were those who reported the use of INSPECT for every prescription (OR, 3.3; 95% CI, 1.3 – 8.5).
The researchers were unable to determine from the survey responses whether the denial of a prescription for a controlled substance was valid. However, they assumed that the refusals were valid, Norwood explained, because the law states that pharmacists must use their clinical judgment and cannot knowingly dispense an invalid prescription.
They also did not know the specific drugs that the pharmacists refused to dispense. “It will be difficult to get agencies to give these data, but that’s the research that needs to be done next,” Norwood explained.
Not a “Magic Bullet”
“This study is informative, but now we need to figure out why pharmacists refuse or choose to dispense controlled substances, and especially what happens when there is refusal,” said Nick Hagemeier, PharmD, PhD, from the East Tennessee State University College of Pharmacy in Johnson City, who was not involved in the study.
“Do the pharmacists have the ability to counsel and refer the patient appropriately concerning abuse and addiction?” he asked.
It is also important to know if the refusals were valid, because a prescription drug monitoring program can contain errors, he said.
“Prescription drug monitoring programs are not a magic bullet,” Dr Hagemeier he told Medscape Medical News. “They alone are not going to solve the problem of prescription drug abuse.”
Everyone has to take ownership of the problem of prescription drug abuse.
Norwood said he agrees that prescription drug monitoring programs are not the only tool clinicians should use to prevent the abuse of prescription drugs, but noted that many healthcare providers are not using these programs at all.
He said he recommends that researchers and public health officials evaluate ways to remove barriers to the use of these programs.
“Everyone has to take ownership of the problem of prescription drug abuse,” said Norwood.
In fact, a call for the mandatory use of prescription drug monitoring programs will be part of the APHA policy statement — Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medications — which will be published on the APHA website early next year.
This research was previously presented at the Indiana Attorney General’s Sixth Annual Prescription Drug Abuse Symposium in Indianapolis. Mr Norwood and Dr Hagemeier have disclosed no relevant financial relationships.
American Public Health Association (APHA) 2015 Annual Meeting: Abstract 317801. Presented November 3, 2015.