Cardinal Health Discusses Prescription Drug Misuse Prevention

Steve Lawrence, senior vice president of Independent Sales at Cardinal Health, spoke with Pharmacy Times about Generation Rx and the company’s efforts to prevent prescription drug misuse.

Pharmacy Times: Can you give a brief overview of Generation Rx?

Steve Lawrence: Starting 10 years ago, we partnered with the college of pharmacy at Ohio State University to address concerns around prescription drug misuse. [W]ith the college of education there at the Ohio State University College of Pharmacy and through a grant from our foundation, [they] created the first Generation Rx presentation. From then, they’ve created age-related presentations from elementary school all the way up to senior citizens, in English and Spanish, and put it on basically a public website where they’re downloadable so that any person can take these to schools, community events, and talk about the effects of prescription misuse.

We really wanted to focus on 4 areas: to teach people about how to take their medication appropriately and only for the person it’s written for; never share your medications, the storing of medications is very important; and how to go out in the community and talk to others about it. So those were the 4 pillars that we built it around and it’s come a long way.

PT: Can you describe the multi-pronged approach?

Lawrence: Generation Rx is solely focused on prescription drug misuse. It focuses on all age groups and teaches people how to take medications appropriately, how to store them, and all those kinds of things. The multi-pronged approach really comes more from the Cardinal Health Foundation.

We saw that the [prescription drug misuse] problem is widespread—education is 1 portion of it, but there’s other things that we felt we could do as Cardinal. A few years ago, we ventured out into some other areas and we really focused on the Drug Takeback Day. We’ve partnered with some of our customers, like Kroeger, with some of our independents across the country, and have donated some takeback boxes to some customers. That’s a perfect place where you can take the medication, it’s given to law enforcement, and then it’s properly destroyed. So that was a big initiative of ours.

We also wanted to go into best practice around medication prescribing and physician engagement. And then we went into community relations. And we thought through that multi-prong approach, if we took money and spread it through each one of those, it would be much more impactful than just focusing on 1 of them.

PT: Explain how Generation Rx has grown, what’s changed about the program, and what you think its future is.

Lawrence: Generation Rx started 10 years ago and it started with 1 presentation. It’s now gone to elementary school, middle school, high school, and college. We have a working environment presentation because we see a lot of prescription misuse in the workplace. And then for senior citizens, it really talks a lot about locking your medications up.

[T]hrough working with the college of education and the college of pharmacy at Ohio State University, we’ve expanded that into a lot of different presentations. Our pharmacy customers are huge advocates of this and do presentations all the time. We’ve also seen that over 100 universities have created Generation Rx chapters, and they actually work toward an award given to them by [the American Public Health Association]. [I]t’s a neat award that over 100 universities have really taken it to heart.

We partnered with several different schools and universities across the country. One in particular was the Warren Albert Medical School at Brown University, [who] hosted a symposium with about 90 medical schools to talk about safe practice of pain management medications. The effort there was to get a lot of educators involved who see this firsthand and teach students to think about what could they create. Out of that, over the next few years, there is going to be a curriculum that is taught to physicians as they go through school about safe practices, safe prescribing habits, and pain management, and how to potentially use less opioid medications, which I think will be a huge benefit to all of us.

We also worked with the Ohio Hospital Association and I think we awarded them about a half-million dollars in grants over a couple years to really focus in Ohio with their hospitals to do a similar thing that the educators are doing. Which is, how can you work with your physicians in your hospitals to create the same safe practices on pain management through the Ohio Hospital Association. They have done some post-degree training for physicians […] through CE and it’s been very well received by the physicians in that group. We’ve seen a drastic reduction in some of the opioid prescribing in Ohio out of that group. So that’s been really rewarding.

And then the other piece we did is we picked 4 states—we had West Virginia, Ohio, Tennessee, and Kentucky—and we donated Narcan to the first responders because that’s a huge issue when you have somebody that’s had an overdose. [T]hrough requests from those organizations we ended up donating about 75,000 doses to the first responders in a lot of communities, to obviously go to great use to help solve this problem.

So, throughout all of that, I think it’s been a huge growth. We’ve used Generation Rx as a launching pad to kind of say how can we then go even deeper into the communities and really have a bigger impact?

PT: How do you see it growing even further than it has?

Lawrence: Well the epidemic we have is large and the growth is going to happen almost by definition—it’s just necessary. More and more people are impacted, and the more people that see this face-to-face—I mean, I see it in our customers. When a customer of ours has a patient or a loved one, a family member, that gets involved or has some issues with drugs, they get heavily involved in this stuff. And so, we’re seeing the advocacy at the local level expand every single year. I get more and more requests of, “Hey, where can I get the information? Can I get somebody to go and do a presentation with me?”

From a Cardinal Health perspective, we continue to look at more and more communities. [So], we’re going to broaden the community outreach and see where we can have the biggest impact, where we have connections in communities where we see the biggest need, and also where there’s a great partner. Because it really takes a great partner that is in the community, that knows the community—they’ll have the biggest impact. For us, for anybody to try and go into communities where you don’t have the relationships, it’s a little different. So that’s why our customers have been such a huge help. Pharmacists are obviously trusted professionals in the community and in many of the smaller rural areas where this is a large problem, they’re the pillars of the community. [I]f the pharmacist goes into the school and talks, people listen.

So, I think the growth will continue, and my hope is it grows to the point where there isn’t a need for it. If we can stamp out this epidemic of prescription drug misuse, then we’ve accomplished our goal and we can all live happy lives. I don’t know if that’ll ever happen but it’s a dream you can always have. My hope is it continues to grow to where it’s not needed, and that would be a wonderful thing for all of us.

PT: What do you feel are the overall consequences of drug misuse on the national scale?

Lawrence: Well it’s an epidemic [that] is local and it’s national. The way I see it, it’s harder to solve on a national scale and that is why I think we try to focus at the community level. But on the national scale, the epidemic is extremely large, and it causes a lot of pain and lost lives that are unnecessary. I personally don’t believe this thing can be solved with something nationally and you solve the whole thing. It’s going to be everybody working together with thousands of different ideas, different approaches. Different ethnic groups need different approaches, different ages need different approaches, and we learned that with Generation Rx.

You can’t take a high school presentation to elementary school kids and even connect. I mean, if you look at our presentations when you go into the elementary school, you’re playing games with the kids. But the games are really getting them to think about, “If I don’t know where that pill came from, I’m not going to put it in my mouth.” Well you can’t really tell them that, but if you can play a game, then they learn from it. That doesn’t work with senior citizens or college kids, and it’s the same thing here. At a national level, it’s real and it’s causing a lot of problems in our society and within the United States, but if we can solve it community by community, then to me that’s how you solve it.

PT: What is the role of community pharmacy in ending prescription drug misuse?

Lawrence: Obviously there’s 2 pieces to it and why we’ve done the multi-pronged approach that we did. There’s the physician, the prescribing part that is very important, it’s very real. And physicians know it, they own it, they’re taking actions.

Obviously the pharmacist is the person the patient sees, they’re the one that delivers the medication. Even though the doctor prescribed it, they see [the pharmacist] as the expert on medications. If you go into cancer hospitals, the physicians don’t write the protocols anymore for cancer treatments. They go to the pharmacist and they write it and work with the physician. It’s been a huge, rewarding experience for me to see so many pharmacists pick [these prevention techniques] up and run with it. We’ve got pharmacists in chains—in CVS, in Kroeger—in chains that we don’t even do business with, [and] we’ve got retail independents. It doesn’t really matter that we’re a drug wholesaler. We’re part of the society trying to solve this problem and that’s why we did the Generation Rx website the way we did with Ohio State College of Pharmacy, making it public—anybody can do it.

And the last thing I would say is […] if you look at the presentations, anybody can give [them]. If you look at the presentations and you care about your community, you can take them into a school [or] into a senior center and you can have that conversation. Because to solve this problem, you don’t have to get into the scientific, prescription, chemical part that a pharmacist would be able to. You can educate people about, you know, if this drug is written for your mother then your mother should take it. There [are] many drugs that, if taken by somebody that doesn’t need it, they’ll end up in the hospital or even worse. You just look at all kinds of things—blood pressure medicine, blood thinners, all those kinds of things. So that’s why we also wanted to bring it up at a higher level and say any prescription medication misuse is important, and pharmacists play a critical role.

The thing that I’ve been the most proud of is the pharmacy industry, the pharmacists themselves, the state pharmacy associations, the colleges of pharmacy. [T]hey’ve embraced this in a big way and they want more. [W]e continue to work with them and help them every way we can. [I]f they continue down this path, this epidemic will get less and less and someday, if it goes away, we’ll have a much better country on our hands.