Background: Community pharmacists are at the frontline of patient care, yet their role in the opioid epidemic remains unclear. This qualitative study examines the perception of community pharmacists about their role in the opioid epidemic and challenges to fulfilling this role. Methods: A secondary analysis of cross-sectional survey data from an Indiana census of community managing pharmacists was conducted. Qualitative data were coded using a priori and emergent themes. A priori categories included the perceived role of pharmacists in the opioid epidemic and perception of practice barriers. Results: A total of 215 Indiana community managing pharmacists participated in this study. Pharmacists understood themselves as gatekeepers in preventing opioid misuse and overdose. Reported pharmacy practices included providing patient education and communicating with prescribers. Challenges to fulfilling this role included pharmacy structure and operation, lack of patient and provider clarity about pharmacist scope of practice, and pharmacist perception that that there is no available discretionary time to support additional services. Conclusion: Pharmacists believe they have a vital role in combatting opioid misuse and overdose but are hampered by structural aspects of pharmacy practice and lack of recognition of their role. Pharmacy associations and policy partners are encouraged to identify opportunities to address these barriers.
HaffajeeRL, FrankRG.Making the opioid public health emergency effective. JAMA Psychiatry. 2018;75(8):767–768.
2.
ShaferE, BergeronN, Smith-RayR, RobsonC, O'KorenR.A nationwide pharmacy chain responds to the opioid epidemic. J Am Pharm Assoc. 2017;57(2S):S123–S129.
3.
LimJK, BratbergJP, DavisCS, GreenTC, WalleyAY.Prescribe to prevent: overdose prevention and naloxone rescue kits for prescribers and pharmacists. J Addict Med. 2016;10(5):300–308.
4.
CochranG, HruschakV, DeFosseB, HohmeierKC.Prescription opioid abuse: pharmacists’ perspective and response. Integr Pharm Res Pract. 2016;5:65–73.
5.
JonesMR, ViswanathO, PeckJ, KayeAD, GillJS, SimopoulosTT.A brief history of the opioid epidemic and strategies for pain medicine. Pain Ther. 2018;7(1):13–21.
6.
DowellD, ZhangK, NoonanRK, HockenberryJM.Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates. Health Aff (Millwood)). 2016;35(10):1876–1883.
7.
MeyersonBE, AgleyJD, DavisAPredicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016. Drug Alcohol Depend. 2018;188:187–192.
8.
ReiflerLM, DrozD, BaileyJEDo prescription monitoring programs impact state trends in opioid abuse/misuse?Pain Med. 2012;13(3):434–442.
9.
FinkDS, SchleimerJP, SarvetAAssociation between prescription drug monitoring programs and nonfatal and fatal drug overdoses: a systematic review. Ann Intern Med. 2018;168(11):783–790.
10.
RutkowL, ChangHY, DaubresseM, WebsterDW, StuartEA, AlexanderGC.Effect of Florida's prescription drug monitoring program and Pill Mill Laws on opioid prescribing and use. JAMA Intern Med. 2015;175(10):1642–1649.
11.
MoyoP, Simoni-WastilaL, GriffinBA,et al. Impact of prescription drug monitoring programs (PDMPs) on opioid utilization among Medicare beneficiaries in 10 US States. Addiction. 2017;112(10):1784–1796.
12.
DowellD, HaegerichTM, ChouR.CDC guideline for prescribing opioids for chronic pain – United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49.
13.
EvoyKE, HillLG, GroffL, MazinL, CarlsonCC, RevelesKR.Naloxone accessibility without a prescriber encounter under standing orders at community pharmacy chains in Texas. JAMA. 2018;320(18):1934–1937.
14.
ChenQ, LarochelleMR, WeaverDTPrevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open. 2019;2(2):e187621.
ThomasK, MuzykAJ.Surveys of substance use disorders education in US pharmacy programs. Ment Health Clin. 2018;8(1):14–17.
18.
CoxN, TakCR, CochellaSE, LeishmanE, GunningK.Impact of pharmacist previsit input to providers on chronic opioid prescribing safety. J Am Board Fam Med.2018;31(1):105–112.
19.
StrandMA, EukelH, BurckS.Moving opioid misuse prevention upstream: a pilot study of community pharmacists screening for opioid misuse risk. Res Social Adm Pharm. 2019;15(8):1032–1036.
20.
JacobsSC, SonEK, TatC, ChiaoP, DulayM, LudwigA.Implementing an opioid risk assessment telephone clinic: outcomes from a pharmacist-led initiative in a large Veterans Health Administration primary care clinic, December 15, 2014–March 31, 2015. Subst Abus. 2016;37(1):15–19.
21.
DiPaulaBA, MenacheryE.Physician-pharmacist collaborative care model for buprenorphine-maintained opioid-dependent patients. J Am Pharm Assoc. 2015;55(2):187–192.
22.
BounthavongM, HarveyMA, WellsDLTrends in naloxone prescriptions prescribed after implementation of a national academic detailing service in the Veterans Health Administration: a preliminary analysis. J Am Pharm Assoc. 2017;57(2S):S68–S72.
23.
GiannitrapaniKF, GlassmanPA, VangDExpanding the role of clinical pharmacists on interdisciplinary primary care teams for chronic pain and opioid management. BMC Fam Pract. 2018;19(1):107.
24.
BratbergJP, SmothersZPW, CollinsL, ErstadB, Ruiz VeveJ, MuzykA.Pharmacists and the opioid crisis: a narrative review of pharmacists’ practice roles. J Am Coll Clin Pharm. 2019;3:478–484.
25.
KellingSE, Rondon-BegazoA, DiPietro MagerNA, MurphyBL, BrightDR.Provision of clinical preventive services by community pharmacists. Prev Chronic Dis. 2016;13:E149.
26.
HagemeierNE, GrayJA, PackRP.Prescription drug abuse: a comparison of prescriber and pharmacist perspectives. Subst Use Misuse. 2013;48(9):761–768.
27.
MurphyAL, PhelanH, HaslamS, Martin-MisenerR, KutcherSP, GardnerDM.Community pharmacists’ experiences in mental illness and addictions care: a qualitative study. Subst Abuse Treat Prev Policy. 2016;11:6.
28.
HartungDM, HallJ, HaverlySNPharmacists’ role in opioid safety: a focus group investigation. Pain Med. 2018;19(9):1799–1806.
29.
MeyersonBA, JayawardeneW, EldridgeLAFeasibility and acceptability of a proposed pharmacy-based harm reduction intervention to reduce opioid overdose, HIV and hepatitis C. Res Social Adm Pharm. 2019;16:699–709.
30.
BaloughMM, NwankpaS, UnniEJ.Readiness of pharmacists based in Utah about pain management and opioid dispensing. Pharmacy. 2019;7(1):11.
31.
AgleyJ, MeyersonB, EldridgeLJust the fax, please: updating electronic/hybrid methods for surveying pharmacists. Res Social Adm Pharm. 2019;15(2):226–227.
32.
MeyersonBE, DavisA, AgleyJDPredicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions. Int J Drug Policy. 2018;56:46–53.
33.
AgleyJ, CarlsonJM, McNelisAM,et al. ‘Asking’ but Not ‘Screening': assessing physicians’ and nurses’ substance-related clinical behaviors. Subst Use Misuse. 2018;53(11):1834–1839.
34.
SheffZT, NowakCL, MaxeyHL, KelleyTM. Data report: 2013 Indiana physician workforce; 2014. http://hdl.handle.net/1805/5790. Accessed August 17, 2019.
35.
BlouinRA, AdamsML.The role of the pharmacist in health care: expanding and evolving. N C Med J. 2017;78(3):165–167.
36.
BushPW, DanielsR.Health care systems and transitions of care: implication on interdisciplinary pharmacy services. N C Med J. 2017;78(3):177–180.
ReynoldsV, CauseyH, McKeeJ, ReinsteinV, MuzykA.The role of pharmacists in the opioid epidemic: an examination of pharmacist-focused initiatives across the United States and North Carolina. N C Med J. 2017;78(3):202–205.
39.
CochranGT, EngelRJ, HruschakVJ, TarterRE.Prescription opioid misuse among rural community pharmacy patients: pilot study for screening and implications for future practice and research. J Pharm Pract. 2017;30(5):498–505.
40.
CochranG, FieldC, LawsonK.Pharmacists who screen and discuss opioid misuse with patients: future directions for research and practice. J Pharm Pract. 2015;28(4):404–412.
41.
LaffertyL, HunterTS, MarshWA.Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse. J Psychoactive Drugs. 2006;38(3):229–232.
42.
WenthurCJ, CrossBS, VernonVPOpinions and experiences of Indiana pharmacists and student pharmacists: the need for addiction and substance abuse education in the United States. Res Social Adm Pharm. 2013;9(1):90–100.
43.
American Pharmacists Association. AP. Generation RX American Pharmacists Association Academy of Student Pharmacists;2016. https://www.pharmacist.com/apha-asp-generation-rx. Accessed March 25, 2020.
44.
GenerationRx. Generation Rx safe medication practices for life; 2016. http://www.generationrx.org/. Accessed March 25, 2020.
45.
EukelHN, SkoyE, WerremeyerA, BurckS, StrandM.Changes in pharmacists’ perceptions after a training in opioid misuse and accidental overdose prevention. J Contin Educ Health Prof. 2019;39(1):7–12.
46.
KellerME, KellingSE, CorneliusDC, OniHA, BrightDR.Enhancing practice efficiency and patient care by sharing electronic health records. Perspect Health Inf Manag. 2015;12:1b.
47.
RileyTB, AlemagnoS.Pharmacist utilization of prescription opioid misuse interventions: acceptability among pharmacists and patients. Res Social Adm Pharm. 2019;15(8):1032–1036.
48.
DubePA, VachonJ, SiroisC, RoyE.Opioid prescribing and dispensing: experiences and perspectives from a survey of community pharmacists practising in the province of Quebec. Can Pharm J. 2018;151(6):408–418.
49.
WebsterLR.New policing role for pharmacists undermines partnership with prescribers. Pain Med. 2013;14(11):1619–1620.
50.
KahanM, WilsonL, WenghoferEFPharmacists’ experiences with dispensing opioids: provincial survey. Can Fam Physician. 2011;57(11):e448-454–e454.
51.
MarloweKF, GeilerR.Pharmacist's role in dispensing opioids for acute and chronic pain. J Pharm Pract. 2012;25(5):497–502.
HagemeierNE, TudiverF, BrewsterS, HagyEJ, HagamanA, PackRP.Prescription drug abuse communication: a qualitative analysis of prescriber and pharmacist perceptions and behaviors. Res Social Adm Pharm. 2016;12(6):937–948.
55.
LeongC, SareenJ, EnnsMW, BoltonJ, Alessi-SeveriniS.Community pharmacy practice barriers in preventing drug misuse, divergence and overdose: a focus group study. Healthc Q. 2015;18(3):28–33.
