Pharmacists Advocate for Patients Amid Opioid Crisis and Increased Pharmacy Deserts

Timothy D Fensky, RPh, DPh, FACA, director of operations at Advanced Wellness Pharmacy and past president at the National Association of Boards of Pharmacy, emphasizes the critical role pharmacists can play in addressing the opioid crisis and ensuring patient access to essential medications. He highlight the importance of leveraging prescription drug monitoring programs (PDMPs) to track patient data, while noting gaps in data submission from opioid treatment programs. Pharmacists are urged to advocate against policies that create pharmacy deserts in rural areas, where patients may have to travel long distances to fill prescriptions, potentially leading them to seek alternative and unsafe methods. Fensky also calls for pharmacists to collaborate with clinicians to provide emergency medication supplies and referrals to local treatment and support services. Providing education and resources to both pharmacists and patients is emphasized, as is the need to reduce stigma and support family members affected by substance use disorders. The multifaceted approach pharmacists can take to support patients and communities in the face of the opioid epidemic.

Q: What are the best practices for dispensing opioid medications to patients with a history of opioid use disorder?

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Timothy D Fensky: The biggest thing out there is to basically use the tools that are given to us, and on ne of the biggest tools we have out there is the prescription drug monitoring programs (PDMP) that almost every state has, and you can actually query other states if you're on state border other states. They're looking to change this, but the only concern that I have is that the OTP or the Opioid Treatment Programs, are still not really submitting their data into this. So you don't get a full picture of what's happening, but that's the biggest tool that I would takeaway, is querying that, especially on the new patient. There are the [Drug Enforcement Agency (DEA)] red flags. I will say that some of these, I think, are more yellow flags. I can tell you right now, I was just dealing with a problem with a pharmacy who, with the opioid crisis, there's been some stuff with the Department of Justice (DOJ) and the wholesalers, and the wholesaler was shut off, and the pharmacy was shut off from able to get certain control substances. Well, that's causing pharmacy deserts. and when somebody has to go 30 or 40 or 50 and 60 miles, to some of these rural areas to get their medications. It's a red flag that patients traveling long distances to fill prescriptions. Well, you need to take that with a grant. So that's more of a yellow flag, and inquire, and use the PDMP to ensure that where they're coming from, and what's the issue, because there are pharmacy deserts out there when it comes to control substances, especially things like buprenorphine, where pharmacy are just not stocking some of these medications, or they're running into a legal challenge or policy challenge with their wholesale and they can't get those medications at the pharmacy closest to them.

Q: What resources and support services can pharmacists recommend to patients struggling with opioid addiction?

Here's the thing, if you have the ability for public transit to get to a pharmacy, which is usually within in a community, could be 5 miles from your house, you could take public transportation, but if you have to go 60 miles to go get medications in a real rural area, and you don't have the means of a car, you have no way to take you. Now you're kind of maybe slipping back into utilizing something to get over the withdrawal symptoms of staying on these medications. These medications are there for a reason. They help with the therapy. Some people don't need them, but there are those individuals who need them for craving, and the biggest one is the buprenorphine that's out there. If we're not able to get that, they're going to start seeking other alternatives, which may not be in the best health option for them. A lot of times we can actually suggest for some of the pain to alternative therapies, physical therapy, occupational therapy, yoga, acupuncture, just to mention a few. But again, if you really, truly need this medication, and there are pharmacy that aren't going to carry it, or the ones that are going to carry it are 60 miles away, it's not the best interest of the patient. We need to have people advocating for our patients to basically say, "the regulations that are put in place, or the agreements that are put in place, are harming, not only the patients, but also the pharmacy themselves," because just to shut a pharmacy off because they see an increase. Let me back up. There's a pharmacy that I know of that basically the wholesaler, because of the agreements between the wholesalers and the DOJ, basically shut this pharmacy office because they saw an increase in the number of control substances coming to the store. They don't realize that in this area, certain chain pharmacy stuff closed down. Independent pharmacy have closed down. They're the only pharmacy in the area. Now they've been shut off from being able to acquire the medications and doing the right thing for the community. Now, where do these patients go? Now you're forcing that pharmacy to probably have to close, and causing the desert, right? So there's multiple different factors with this. It's having access to the medication, the willingness to be able to dispense the medication, and taking care of the community. If we start having pharmacy shut down, you can get these deserts. So 60 miles may be where people need to go, and they may not be able to get there. I think that when I was in college, everything was run through your social security number, you went for your grade and you were just a number. Well, that's what, that's what's happening. This is just numbers. This is a numbers game, and not actually diving into the numbers to say, "why is that individual coming?" interviewing people "Why are you coming this far?" It's just on the pharmacy, and the pharmacy is the one that's taking the brunt of it, and they're only trying to help those individuals in the community. Again, the numbers are the numbers, but you really need to look at what's truly happening, and if you have to give more information. You get more information, but it's can't be just a hard stop.

Q: How can pharmacists educate patients and their families about the dangers of opioid misuse and abuse?

This is a counseling thing they may not be able to, inn some states, they may be able to, but I haven't seen many. I mean, I would love to see this. I would love to see pharmacists be able to obtain a DEA number, which some states, they can be able to assess a patient, and actually, allow pharmacist collaborating with clinician to extend therapy because Friday nights, it's 5 o'clock run out of their medication. Clinicians already closed. You have to wait the weekend. Why can't they be an access point? The pharmacist be able to dispense three days of buprenorphine or naltrexone, with a either a collaborative practice agreement or a standing one or whatever the case may be, and to be able to do that within the state. I know that we used to refer individuals to detox program, short stay programs, inpatient. We had one close to to my previous job, and we would refer them to a short stay to to get stable, and then refer them down to real rehabilitation programs, like a congregate care living, where everybody's in the same situation, you're recovering, you're all support system for each other. Again, knowing that the different clinical programs within your area, is there a health center nearby that does cognitive behavioral therapy, that with medication for opioid use disorder together, can actually help somebody, and just to do that, referral process is huge, and I think pharmacists don't really know where to to send individuals that are asking for help. They're basically saying, talk to your doctor, instead of saying, "here's what's down the street here," "there's this program over here," and actually referring people out and letting them go find it locally in the community [and] help locally in the community.

Q: What role can pharmacists play in promoting safe opioid prescribing practices?

The one thing I want to tell pharmacists is that there are resources out there that you can either for yourself to get educated or to send patients to. I have a couple of them here. So the Substance Abuse and Mental Health Services Administration or SAMHSA, which is at SAMHSA.gov. They've got a whole host of resources that you can you can utilize telephone numbers, it's got white papers and guidelines for pharmacists. I will say that there's another site called Safe.pharmacy, which NABP, the National Association of Boards of Pharmacy, has put out, where it shows you how to store and properly store, take medications and have disposal them. NABP has also collaborated with the National Community Pharmacy Association, or NCPA, and they do have a document talking about what pharmacists could be doing as well, nd then NABP also has a link on their website on medication treatment. There's a whole page on and resources there as well. So again, it's educating yourself, educating the patient, and educating the public on where they can get these resources, and you have to understand this individual is someone that needs help has a disease state, just like any other disease state, whether it was diabetes or asthma, they need medications in order to stay healthy, and for their own well being, and we need to make sure that we don't allow the public to react the same way you would. You shouldn't react to a patient any other way other than wanting to help them be safe and healthy. The other thing is that I didn't touch on, which I really probably should have touched on, is that there are programs out there that are locally you've got Alcoholics Anonymous, Narcotics Anonymous, and one thing that people really should be referring family members to is Al-Anon/Alateen, which is actually a support group for individuals who have family members or friends who suffer from in a disorder, substance use disorder, or opioid use disorder. It's for them. They also need support, and the pharmacy really needs to support those individuals, as well as the patient themselves.