November 15, 2018
I believe many of us are saddened and even outraged on how the opioid epidemic has spiraled out of control in the US. This epidemic has touched so many lives that many of us may personally know someone that has been either directly or indirectly been affected. From inappropriate health care prescribing, illegal or questionable internet sales, use of social media by drug dealers, pharmaceutical industry turning a “blind eye” and weak congressional legislation have all contributed to the opioid crises. As pharmacists, many of these reasons are simply out of our control and we struggle on a daily basis to determine legitimate vs fraudulent prescriptions. However, there is one simple solution I believe could have made a significant difference on opioid dispensing at the pharmacy counter—a medical indication.
As pharmacists we receive prescriptions with the common information, name, age, drug, etc…. but for decade’s pharmacist have argued for the need to include a medical indication or diagnosis with the prescription. Presently, without a medical indications pharmacists do not have the information needed to assess appropriate drug therapy. We simply put “the drug in the bottle” and make sure it is the right patient, drug, and dose. However, as a part of our education there is something missing here, INDICATION. Remember, during your pharmacy training that INDICATION is ALWAYS NEEDED to ensure appropriate drug therapy. This information helps us to better assess drug therapy for our patients.
Recently, a study in the Annals of Internal Medicine evaluated opioid prescriptions to almost 809 million outpatient visits over a 10 year period with 66.4% where intended to treat a non-cancer pain. However, 28.5% of prescriptions (about 1 out of every 10 patients) there was no record of either pain symptoms or a pain-related condition. 1 Having a medical indication along with a prescription could potentially limit inappropriate prescribing of opioids, thus, having a positive outcome of the number of patients receiving these addictive medications. Dr. Sherry the lead author of the study is quoted in saying “If a doctor does not document a medical reason for prescribing an opioid, it could mean that the prescription is not clinically appropriate”. 1
This study demonstrates that the lack of a medical indication is essential to ensure appropriate and safe prescribing. Pharmacists should demand that all prescriptions, not just opioids, should have a warranted medical indication to prevent ongoing poor drug therapy practices and thus preventing significant adverse drug events.
Michael J. Cawley, PharmD, RRT, CPFT, FCCM, is a professor of clinical pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has more than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.
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- Sherry TB, Sabety A, Maestas N. Documented pain diagnosis in adults prescribed opioids: Results from the National Ambulatory Medical Care Survey, 20006-2015. Annals of Intern Med 2018. Available at file:///C:/Users/m.cawley/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/AIME201811200-M180644.pdf. Accessed September 22, 2018.