Opioid abuse has been garnering more attention as the public and private sectors take steps to address the increasing number of opioid-related overdose deaths.

For instance, the US Centers for Disease Control and Prevention recently released new explain what “as needed” means on medication labels. Patients should know that they can take less, but not more, than the maximum amount of medication listed on the label for a 24-hour period.

As the gatekeepers for prescription painkillers, pharmacists play a key role in preventing and identifying opioid misuse and abuse.

The problem is personal for Massachusetts Pharmacists Association President Karen Horbowicz, PharmD, RPh, BCPS, as she was held up at gunpoint by a drug seeker a few years ago.

Here are Dr. Horbowicz’s tips for pharmacists to address the issue.

1. Educate patients about opioids and set realistic expectations for pain control.
Dr. Horbowicz highlighted the need to weigh the risk for abuse and addiction with the benefit of pain relief among those with legitimate pain.

Other alternatives should be considered, but if an opioid is required, then pharmacists should take the time to educate patients.

“This is particularly important if the medication is going to be required long-term since the risk of addition is higher,” Dr. Horbowicz noted. “Patients should leave the pharmacy knowing the following: how to take their medication, the side effects (including the potential for addiction and overdose), how to safely store their medication, and where to dispose of any remaining medication once they no longer need to take it.”

Pharmacists could also set realistic expectations for pain control in order to avoid a situation where a patient takes more and more medication to curb all pain.

“This will not only help to prevent misuse that could lead to addiction, but also prevent overdose,” Dr. Horbowicz said.

Similarly, Steve Leuck, PharmD, suggested that pharmacists should explain what “as needed” means on medication labels. Patients should know that they can take less, but not more, than the maximum amount of medication listed on the label for a 24-hour period.

During this counseling session with the patient, the pharmacist can stress the importance of not sharing prescription medications with anyone. In addition, the pharmacist can remind patients that if they don’t feel better or if their pain gets worse, then they should call their physician, Dr. Leuck noted.

2. Recognize the signs of opioid addiction. 

Dr. Horbowicz said she starts to get concerned when a patient consistently asks for prescriptions to be filled early, with no dose escalation indicated by his or her prescription.

Other signs could be defensiveness about the early fill request or concerns about the pharmacist contacting the prescriber. The patient may also appear angry or combative when the pharmacist denies the early refill.

Dr. Horbowicz also noted that patients may show signs of withdrawal at the counter, or they may look disheveled, as if they’re neglecting personal hygiene.

“As the eyes and ears of the health care system, it is our responsibility to bring our observations and concerns to the attention of the prescriber,” she said.

3. Use a prescription drug monitoring program (PDMP).

In addition to helping pharmacists preventing pharmacy robberies, but Dr. Horbowicz did provide a few tips to reduce the risk.

Start with an armed robbery plan and make sure all staff members know what to do in the event that someone tries to steal something, since preparation will help keep everyone safe.
Dr. Horbowicz also recommended reaching out to local police prior to an emergency.

“They will be able to assist you in identifying weak points in your security system, as well as provide you with contacts for nonemergency situations,” she said.

Pharmacists should also make sure they’re up-to-date on technology for their security system. High-definition cameras can be helpful inside and outside the building.

Dr. Horbowicz suggested that pharmacists should make their presence known in the pharmacy by greeting customers as they enter and asking if they need help.

“Those that have a legitimate reason for being in your pharmacy will appreciate the help and those who do not will be more likely to leave,” she said.

It’s her hope that robberies will decrease in frequency as the demand for opioids decreases. However, she stressed that pharmacists need to be active participants in combatting the opioid abuse crisis.

“I encourage all pharmacists to get actively involved in their own communities through partnering with public and private entities like local coalitions,” Dr. Horbowicz said. “Only by working together will we get this problem solved.”

4. Put a plan in place in case a robbery occurs.

There’s no magic bullet, so to speak, for preventing pharmacy robberies, but Dr. Horbowicz did provide a few tips to reduce the risk.

Start with an armed robbery plan and make sure all staff members know what to do in the event that someone tries to steal something, since preparation will help keep everyone safe.
Dr. Horbowicz also recommended reaching out to local police prior to an emergency.

“They will be able to assist you in identifying weak points in your security system, as well as provide you with contacts for nonemergency situations,” she said.

Pharmacists should also make sure they’re up-to-date on technology for their security system. High-definition cameras can be helpful inside and outside the building.

Dr. Horbowicz suggested that pharmacists should make their presence known in the pharmacy by greeting customers as they enter and asking if they need help.

“Those that have a legitimate reason for being in your pharmacy will appreciate the help and those who do not will be more likely to leave,” she said.

It’s her hope that robberies will decrease in frequency as the demand for opioids decreases. However, she stressed that pharmacists need to be active participants in combatting the opioid abuse crisis.

“I encourage all pharmacists to get actively involved in their own communities through partnering with public and private entities like local coalitions,” Dr. Horbowicz said. “Only by working together will we get this problem solved.”