Pharm Report Issue No. 9

A newsletter to update clinic staff on current issues in healthcare

Issue IX

Opioid Safety

Opioids, even those available as a prescription can be dangerous. The CDC reported that between 1999 and 2019, more than 564,000 people died from an overdose. Wisconsin has been hard-hit by the opioid crisis. In Wisconsin, annual opioid overdose deaths outnumber annual motor vehicle deaths. The annual number of opioid overdose deaths have been increasing and there were more than 11 times as many opioid deaths in 2020 as there were in 2000. There were 3 times as many opioid-related emergency room visits in 2020 as there were in 2007.

Healthcare providers and pharmacies can work together to help reduce the risk opioids pose to our patients. Some risk mitigation strategies include:

• Check the Wisconsin Prescription Drug Monitoring Program (PDMP) before prescribing any opioid to a patient. This will help identify opioids (and other controlled substance prescriptions, such as benzodiazepines) prescribed by other providers. This can also help the provider spot potential red flags for risky behavior such as multiple prescribers, multiple pharmacies, and early fills.
• Provide patients with information on risks associated with opioid medications, proper storage and disposal of medications, and the harms (and illegality) of sharing medications with other people.
• Prescribe Naloxone to patients receiving opioid prescriptions. Naloxone is an opioid reversal agent that can be administered intranasally. It is available over the counter, but many insurance plans cover this potentially life-saving medication at a lower cost.
• Identify high risk patients, such as those with concurrent prescriptions for benzodiazepines (eg. alprazolam, diazepam, lorazepam) and those taking greater than 50 morphine milligram equivalents of an opioid per day, and working to reduce risk by reducing dosages and finding alternative medications.

Prescription Tips

• When prescribing an opioid, please put a fill date on the prescription. This tells the clinic staff, patient, and pharmacy the soonest the prescription can be filled. Federal law prohibits filling a prescription before this date, and in order to change this date, a new prescription must be issued; the date cannot be changed over the telephone.
• For patients who take opioids chronically, consider writing prescriptions for 28 days instead of 30. This avoids early fills due to weekends and makes identifying early fills easier because it does not rely on monthly fills, which can have 28, 29, 30, or 31 days.
• When writing a prescription for an opioid with variable dosage, such as, “take 1 tablet every 4 to 6 hours as needed for pain,” include the maximum number of tablets or capsules the patient can take per day as well as how long the prescription must last.
  • Example: Oxycodone 5mg tablets #112: Take 1 tablet every 4 to 6 hours as needed for pain. No more than 4 tablets per 24 hours. 112 tablets must last 28 days. Earliest fill date: March 15, 2024.
• As always, if you have any questions, call the pharmacy!

Do you know another provider who would be interested in receiving Forward Pharmacy’s Pharm report? We invite you to forward this email, or share our signup link: https://forwardpharmacywi.com/pharm-report/