You can help recognize and reduce patient misuse of controlled substances (opioids, benzodiazepines, stimulants, etc).
Over 16 million people in the US use Rx meds in ways other than prescribed...and overdose deaths continue to rise.
Work as a team to find the balance between legitimate use and misuse...and keep the focus on safety and good patient care.
Recognize. Continue to stay alert for red flags, such as early fills...demand for certain brands...or frequently lost or stolen Rxs.
Help review fill histories or your state’s prescription drug monitoring program (PDMP) for potential issues, such as Rxs from multiple pharmacies or prescribers...or pet Rxs for the same med.
Keep noncontrolled meds on your radar too. For instance, clonidine or quetiapine may be misused to enhance opioid effects...and loperamide or venlafaxine may be misused for euphoria.
Respond. Remember that red flags aren’t stop signs...but they’re a signal to take a closer look.
Notify your pharmacist if you have concerns...and work together to get more info from the patient or prescriber if needed.
For example, you may need to ask the patient how they take the med...and check this against the Rx directions.
Be discreet, use a normal tone of voice, and avoid stigmatizing language. A patient may be taking extra doses of a med under the prescriber’s permission...without notifying the pharmacy first.
Reduce. Take steps to stop misuse before it starts.
Ensure controlled substance Rxs have an auxiliary label stating, “Federal law prohibits transfer of this drug to any person other than for whom it was prescribed.” Most people who misuse stimulants (methylphenidate, etc) get them from family, friends, etc.
Refer patients getting new Rxs for pharmacist counseling...to discuss risks and set realistic expectations. For instance, improving function is the goal of chronic pain meds...not to be pain free.
Advise storing Rxs in a secure place and disposing of unused meds properly...to reduce the chance of them getting into the wrong hands.
- https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/overview (5-24-23)
- https://www.fda.gov/drugs/drug-safety-and-availability/fda-updating-warnings-improve-safe-use-prescription-stimulants-used-treat-adhd-and-other-conditions (5-24-23)
- J Pharm Technol. 2020 Oct;36(5):211-217
- Technician Tutorial: Controlled Substances Basics