Making Lemonade out of Lemons: Fighting the Opiate Epidemic

We pharmacists have found ourselves stuck in the crossfire of a national opiate epidemic. We are now seeing patients walk into our stores with prescriptions for counts of oxycodone from 30 mg #120 to quantities as high as #360. Sometimes the patients can barely walk; in worst-case scenarios, they present prescriptions for these large quantities of opiates for several people in their car—all with the same diagnosis. We are also noticing a trend in our hospitals. Patients often come into the hospital reporting a spider bite. These “spider bites” are often adjacent to track marks up and down the arm. Many patients admit that they’ve been injecting Opana, Suboxone, and oxycodone.

Let me tell you a little bit about me, my practice site, and our community that I call home. I’m a fourth-generation health care practitioner in LaFollette. We’re located in rural Appalachia about 40 miles north of Knoxville, situated on the Kentucky line. Interestingly, the neighboring county south of us is one we often compete with for #1 in the state for methamphetamine production and use. The picture I’m painting might sound like a living hell to some, but it’s not. We, like the rest of our nation, are fighting in the war against a prescription opiate epidemic. We have limited resources, a population that lives below the national poverty level, and a limited number of job opportunities. Our jails are overpopulated, and most inmates are there as the result of drug abuse or petty theft related to drug abuse.

Although our statistics are frightening, we are a close, rural town. When tragedy and heartache strike, our community is quick to band together. Many churches in the community are the fibers that weave the close-knit community. They also offer a refuge for children and families dealing with drug addiction in their families. As this epidemic grows in the drug-ravaged communities of rural Appalachia, education is the only way for our kids to learn differently.

couple of years ago, I found myself at a crossroads in my pharmacy career. Our county was surrounded by pain clinics and Suboxone clinics. Drugs abuse was rampant and drug seeking was a problem. Like many of you working in independent and retail settings, you meet these patients who demand that you fill their prescriptions. The scenario is very similar all across the United States: the patient is not on maintenance medications, doesn’t have a primary care physician, and they have the same list of medications—benzodiazepine, long-acting opiate, short-acting opiate, gabapentin, and muscle relaxer. Ironically, they also all have the same diagnosis code. Then we’re stuck with the moral and ethical decision: do we fill it? Do we send them on their way? Once you refuse the prescription, the abuse begins. Often times the patients won’t take no for an answer, and before you know it, the police are there. This not only takes time away from other patients, but it also inevitably happens when we have a store full of people. This is what I was dealing with on regular basis.

Back to the crossroads; I knew that I either needed to find a new position in the corporation or find a means to channel my frustrations into something positive. I partnered with a local nonprofit organization called Community Health of East Tennessee (CHET). And that’s where the story begins! We launched GenerationRx—a tool developed by Ohio State University College of Pharmacy and Cardinal Health. The curriculum is broken down into elementary, middle, and high school groups. The program provides tools such as games, lessons, and activities that all promote the same message of preventing drug abuse and misuse.

Upon discovering this program, I knew that if we went into schools one time only, it would be ineffective. So once our partnership with CHET began, we developed our program based on repetition. We rotate through the elementary and middle schools throughout the school year. We have an 8-week rotation in the schools, followed by a graduation ceremony and, of course, a pizza party. Each week during the rotation, we work through the different topics, play games such as “Good Choices vs. Bad Choices” or “Is this Medicine or Is this Candy?” At times, I wonder if they’re listening to me, but then we run into them in the community and they say, “Hey she taught me about drug abuse and misuse.” We know here in rural Campbell County, we can’t fix the drug epidemic overnight, but we can work each year with kids as they get older to help provide the tools to help them make better decisions.

Raewyn T. Snodderly, PharmD, works at Terry's Pharmacy in Lafollette, Tennessee.