Few options available to pharmacists who identify opioid over-prescription
Refusing to fill a prescription comes with complicated considerations
When opioids are over-prescribed, or improperly prescribed, pharmacists are the last line of defence against overuse and abuse, but their power is limited to reporting the issue or simply refusing to fill the prescription.
The first step, however, is to go straight to the source.
"Contact the prescriber and ask for clarification, or ask questions about the prescription. We're partners in the prescription review program," said Jeana Wendel, registrar at the Saskatchewan College of Pharmacy Professionals.
The program, created in 2006, monitors for inappropriate prescribing of drugs deemed subject to misuse or abuse. Opioids are included in the list.
Partners in the program, including the College of Pharmacy Professionals and the College of Physicians and Surgeons, work together to report and investigate issues.
Recently a doctor in Kamsack, Sask., was charged with improperly prescribing opioids to his patients. The charges stemmed from activity tracked by the review program.
Collaboration is key
Beyond speaking with the physician or nurse-practitioner doing the prescribing, the pharmacist can make a formal complaint to the College of Physicians and Surgeons.
If the problem persists, it is at the discretion of the pharmacist whether or not to refill prescriptions, though the move could have repercussions for the patient.
"The patient is obviously in need of something, and what that is or the correct way to get it to the patient and the correct dosage? All of that would have to be considered," said Wendel.
Addictions specialist Dr. Peter Butt agrees with Wendel's assessment that refusing to fill prescriptions may not be the most effective stance.
"With opioids, for example, if a person suddenly stopped they would go into withdrawal," he said.
Other considerations include whether the pharmacist is biased against the patient, or in the process of stereotyping them.
Butt suggests giving the patient a partial refill while the issue is sorted out.
Some pharmacists would prefer to have the ability to change the prescription, but there are implications to that, too.
"The collaboration is absolutely key here," said Butt.
"If you have one person prescribing and another person dispensing something completely different, there's going to be problems. There needs to be good communication, a treatment plan, and somebody has to be in charge."