Prescription opioid use: Patient characteristics and misuse in community pharmacy

Abstract

Objective Opioid pain medication misuse is a major concern for U.S. public health. The purpose of this article is to: 1) describe the demographic and physical, behavioral, and mental health characteristics of patients who fill opioid medications in community pharmacy settings and 2) describe the extent of opioid medication misuse behaviors among these patients. Design We recruited and screened a convenience sample of patients using a tablet computer-based assessment protocol that examined behavioral, mental, and physical health. Descriptive and inferential statistics were calculated to describe respondents and their opioid medication misuse and health characteristics. Setting Patients were screened in 2 urban and 2 rural community pharmacies in southwestern Pennsylvania. Participants Survey participants were adult patients filling opioid pain medications who were not currently receiving treatment for a cancer diagnosis. Main Outcome Measures Validated screening measures included the: Prescription Opioid Misuse Index, Alcohol Use Disorders Identification Test-C, Short-Form-12, Drug Abuse Screening Test-10, Primary Care Post-traumatic Stress Disorder (PTSD) screen, and the Patient Health Questionnaire-2. Results A total of 333 patients were screened (71.2% response rate). Nearly the entire population reported pain above and general health below national norms. Hydrocodone (19.2%) and morphine (20.8%) were found to be the medications with the highest rates of misuse—with hydrocodone having higher odds for misuse by more than four times compared to other medications (AOR=4.48; 95% CI=1.1–17.4). Patients with positive screens for illicit drug use (AOR=8.07; 95% CI=2.7–24.0), PTSD (AOR=5.88; 95% CI=2.3–14.7), and depression (AOR=2.44; 95% CI=1.0–5.9) also had significantly higher odds for misuse compared to those with negative screening results. Conclusion These findings provide important foundational data that suggest implementation of regular opioid misuse screening protocols within community pharmacies. Such screening activities could foster a culture of prevention and overall reduction for misuse among patients filling opioid medications in community pharmacies.

Community pharmacists' contribution to public health: assessing the global evidence base

“…Lack of knowledge and confidence in providing the service were identified as barriers [71], a finding that is similar to that from another survey involving community pharmacists in New Zealand and England [73]. A study from the United States, that recruited and screened a convenience sample of patients with the use of a tablet computer-based assessment protocol, showed a high prevalence of drug misuse in the study population and considered the feasibility of implementing regular opioid misuse screening protocols within community pharmacies [74]. Taken together, these studies indicate the viability of providing alcohol dependence advice and drug misuse services in community pharmacies, although further studies on effectiveness are needed.…”

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

“…Alcohol, marijuana, and opioids frequently take center stage in public policy and debate as concerns remain focused around opioid misuse and overdose, 1,2 ongoing drinking problems, 3 and liberalization of marijuana use policies. 4,5 Persons who excessively use these substances face the risk of developing an associated SUD, 6 which can have considerable implications for patient health and health systems, 15 in part by contributing to high use of ED services.…”

A community pharmacy intervention for opioid medication misuse: A pilot randomized clinical trial

“…2,3 A self-report screening was selected (opposed to biochemical screening) because: (1) self-report is less invasive for patients than biochemical tests (e.g., urine, blood); (2) self-report measures are easily completed as patients wait for medications to be filled; (3) self-report screening is in-line with current screenings in general medical settings, and (4) our previous research has shown a non-trivial portion of patients will self-report misuse. 24…”

“…Our previous research has documented that there is significant pharmacist interest in engaging patients who misuse opioid medications, 18,19 and that patients can be identified for misuse in this setting. 20 Specifically, our previous research of 333 adult non-cancer patients filling opioid pain medications in 4 rural/urban community pharmacies showed opioid medication misuse among 15.1% of patients. 20 These data also documented those positive for misuse have high rates of concomitant health problems that increase chances for misuse, which include depression (49%), post-traumatic stress disorder (PTSD; 37.5%), hazardous alcohol use (31.3%), illicit drug use (22.5%), and levels of poor general health (89.6%) and severe pain surpassing US norms (91.8%).…”

“…20 Specifically, our previous research of 333 adult non-cancer patients filling opioid pain medications in 4 rural/urban community pharmacies showed opioid medication misuse among 15.1% of patients. 20 These data also documented those positive for misuse have high rates of concomitant health problems that increase chances for misuse, which include depression (49%), post-traumatic stress disorder (PTSD; 37.5%), hazardous alcohol use (31.3%), illicit drug use (22.5%), and levels of poor general health (89.6%) and severe pain surpassing US norms (91.8%). A total of 98% of patients with misuse had ≥1 of these concomitant health conditions.…”