Recent opioid report is raising questions. Here are some answers. | NCPA Executive Update | August 2, 2019

NCPA August 1, 2019

Dear Colleague,

Doug Hoey

We live in a short-attention-span, 24-hour news cycle world where we are constantly bombarded with one "blockbuster" story after another. Big "scoops" are all over the news one day and forgotten the next.

That hasn't been the case with the story that broke 10 days ago providing more detail about the opioid epidemic affecting our country. This story has staying power because regardless of your view on any number of polarizing subjects, drug abuse is a great concern for everyone.

Here's a quick refresher: As a result of a lawsuit by the Washington Post and West Virginia-based HD Media, a federal judge recently ordered the release of controlled substance distribution and sales data that had previously been sealed and was only available to the Drug Enforcement Agency. According to the DEA, the Automation of Reports and Consolidated Order System, or ARCOS, is "an automated, comprehensive drug reporting system which monitors the flow of DEA controlled substances from their point of manufacture through commercial distribution channels to point of sale or distribution at the dispensing/retail level – hospitals, retail pharmacies, practitioners, mid-level practitioners, and teaching institutions."

The Washington Post reports that the ARCOS database shows 76 billion prescription oxycodone and hydrocodone pills were distributed from 2006 through 2012. The Washington Post analyzed the data and compiled it into a format that is searchable at the county and state levels, allowing "readers to learn how much hydrocodone and oxycodone went to individual states and counties, and which companies and distributors were responsible." That means that if your pharmacy dispensed a prescription for opioids between 2006-2012, your pharmacy is listed in the database. If you haven't already, look up your state and/or county results in the Post's analysis of the ARCOS database.

The ARCOS database is a very important tool and has information that could help the DEA shut down pill mills and identify the few crooked prescribers whose prescriptions are the fuel for pill mills. Without the prescriber writing a prescription, there is no action for the pharmacist to take.

However, the data is only data without any meaningful context. For example, a pharmacist's responsibility to use professional judgment when caring for patients to alleviate suffering while practicing at the highest ethical standards is not reflected.

NCPA has been contacted by a few media outlets concerning the role of independent pharmacies in this story. Here are some of the questions we've been asked, followed by our responses:

"Why do you think independent pharmacies are on some of the listings of the top prescription opioid dispensing pharmacies in their state?"

There are a variety of reasons, including:

  • Community pharmacies are the pharmacy that many patients turn to when their medical condition requires time and attention that does not always fit with the service from a big chain.

  • A number of community pharmacies are near a cancer center, surgical center, or hospice facility. Again, this kind of patient base can skew numbers.

  • Some independents are high-volume prescription pharmacies. They dispense a higher number of controlled substances, but that number is proportional to their overall prescription volume.

What are community pharmacies doing to help stop the opioid epidemic?

Some of the proactive steps community pharmacies have taken include:

  • Continuing to evaluate prescriptions to attempt to detect forgeries or alterations.

  • Supporting electronic prescribing, which has helped eliminate some of the forgery efforts that drug seekers will attempt.

  • Taking part in Dispose My Meds, which has a locator tool with more than 2,100 participating sites across the country.

  • Using Allied Against Opioid Abuse's Pharmacy Toolkit, which the National Community Pharmacists Association helped prepare to aid pharmacists in the sometimes difficult conversations with patients and caregivers regarding opioid prescriptions.

  • Advocating for greater pharmacist access to naloxone, which has resulted in increased access across the country, and in turn, lives saved.

What else should be done to stop the opioid epidemic in the U.S.?

The pharmacy community wants to continue to do its part. Steps have been taken to educate prescribers about prescribing opioids, including prescribing appropriate quantities. Even greater diligence is being conducted before an opioid prescription is dispensed. As a result of the many steps being taken, opioid prescriptions are down 28 percent. And, despite an increase in the use of illicit opioids such as heroin, synthetic fentanyl analogs, and cocaine, deaths from legitimate and illicit opioids is down 5 percent (perhaps partially as a result of greater pharmacist access to dispense naloxone). There is still much more work to do for everyone in our country to stop drug abuse and community pharmacies want to continue doing our part.

NCPA also is sharing our opinion that the DEA should monitor and take immediate action against prescribers operating "pill mills" and those who prescribe large volumes of Schedule II drugs AND any pharmacies knowingly supporting these pill mills.

Drug abuse is not new, but the magnitude of the current crisis is unprecedented. Pharmacists have been working to do their part in preventing opioid abuse, but community pharmacists are only one link in the chain. There are some encouraging initial signs of progress but for this terrible problem to be eradicated, every link in the chain must do its part.


Doug Hoey