Inside: Millions of Americans still misuse opioids. But your independent community pharmacy can help. Learn how to help protect your patients through conversation, education, and a keen eye.
The opioid epidemic remains in full force.
The alarming problem has prompted action from both private and political parties. But it still isn’t enough. Fatal overdose rates continue to rise across the country.
Pharmacists uniquely stand in the gap between the dangerous drugs and patients. No one is better positioned to help curb rising opioid misuse.
And, independent pharmacists, in particular, know their patients and their drug patterns better than anyone else.
Which makes you one of the most important figures in the fight against opioid abuse. The Centers for Disease Control and Prevention (CDC) said, “On the front lines of dispensing opioid pain medications and providing medication-related services, pharmacists can serve as a first line of defense by engaging in prevention and treatment efforts of opioid use disorder and overdose.”
But do you know how to address the opioid misuse with patients? Do you know how to spot red flags?
These Are the Best Ways to Talk About Opioids with Your Patients
Opioid misuse is a sensitive issue.
One wrong statement to patients could offend them and turn them away. One word left unsaid could be a missed opportunity to prevent misuse.
We have some tips you can follow to skillfully and effectively navigate opioid abuse issues with your patients. Compiled from a CDC brochure, these recommendations can bolster your relationships with patients and potentially save lives.
Ask the right questions
When dealing with sensitive issues, questions work better than statements.
Sometimes it takes a few strategic questions to coax important information from patients.
Questions also serve as an easy way to get the conversation started.
The CDC recommends asking your patients these questions:
- What medications are you taking?
- What medications have you taken to manage pain and how did you respond?
- Describe how you normally take your medications.
- How well is your medication controlling your pain?
- Are you experiencing any side effects from your pain medications?
- In addition to medications, what other ways are you managing your pain?
- Do you know which medications you should avoid while taking opioids?
- What questions do you have about your medications?
Ask questions in the right way
The way you ask a question makes a big difference in how patients will respond.
People are naturally skilled at noting tone of voice and body language, especially when discussing personal and sensitive topics.
Accusatory and judgmental tones will cause patients to wall up. Compassionate and kind tones make them more receptive.
Approach your questions in these ways:
- Ask open-ended questions instead of “yes” or “no” questions
- Use empathy
- Speak in plain language
- Listen actively
- Take your time
Establish trust with your patients
Trust primarily grows over the long-term. Everything you do leading up to your conversation lays the groundwork for how trusting the patient will be.
“Effective strategies for working with patients with chronic pain are not learned in a single session,” the CDC said in a training module on applying the CDC’s Guideline for Prescribing Opioids. “They must be practiced, reviewed, and applied consistently over time.”
Learn how to build trust with patients for the long haul.
But you can also build trust in a single conversation. Consultants and salesmen learn how to do this proficiently to win over customers.
“It turns out that human beings are hard-wired to have conversations impact them in such profound and significant ways that it can actually turn genes on and off,” Judith Glaser, author of Conversational Intelligence, told Psychology Today.
The most effective way to earn trust quickly is to make your patient feel valued. “Anything that has some sense of, ‘You have value.’ That hits a person in their heart as feeling important and valuable. You can almost say anything once you’ve done that,” Glaser said.
Ways to make a person feel valued and to build trust:
- Give them your full attention
- Acknowledge and validate their concerns
- Compliment them genuinely
- Listen more than you talk
- Maintain eye contact
- Use positive body language
Educate your patients about opioids
After you’ve asked the right questions in the right way and established trust, it’s time to educate your patients.
The right questions allow you to tailor your education to their particular context. Their trust prepares them to listen to your recommendations.
The CDC recommends pharmacists discuss these five topics to educate patients:
1. How to store and dispose of unused medications
2. Why patients shouldn’t save unused medication
3. Why it’s important to fill all medications at a single pharmacy
4. The common side effects and the importance of reporting them
5. How to take medication as prescribed and the risks of inappropriate medication use
Monitor your patients who take opioids
Preventing opioid misuse doesn’t rest solely on your patients’ shoulders, even after you’ve properly educated them.
As their medication consultant and provider, you can take proactive steps to help prevent misuse.
But the CDC recommends you don’t do it alone. You’ll be more effective in collaboration with prescribers.
“Pharmacists and prescribers should apply the guideline and work collaboratively to optimize pain management while preventing opioid use disorder and overdose,” the CDC said. “Establishing and maintaining collaborative working relationships improves patient outcomes.”
Collaborations include working together on treatment plans, monitoring drug use, and using Prescription Drug Monitoring Programs (PDMP).
How to Spot Red Flags of Opioid Misuse
Pharmacists should develop a skilled eye for signs of opioid misuse. Of all the healthcare providers, pharmacists have the best viewpoint for spotting suspicious signs in patient behavior.
The CDC recommends keeping an eye out for these red flags:
- Forged prescriptions
- Prescriptions originating from outside the immediate geographic area
- Altered prescriptions
- Cash payments
- Inconsistent or early fills
- Multiple prescribers
Spotting Forged Prescriptions
Forged prescriptions take many forms. If you don’t know what to look for, they might sneak past you.
Look for these signs of forgery from the DEA’s Pharmacist’s Guide to Prescription Fraud:
- Prescriptions that feature handwriting that looks too good (for example, the physician’s handwriting is too legible)
- Prescriptions or directions that don’t comply with standard abbreviations or appear to be copied from textbooks
- Quantities, directions, or dosages that differ from usual medical usage
- Prescriptions that appear to be photocopied
- Prescriptions written with different colors of ink or written in different handwriting
Other strategies to spot red flags include consulting the PDMP and verifying and communicating with the patient’s prescriber.
Recognizing Illegitimate Scripts
Forgeries are one type of illegitimate prescription. Patients can produce illegitimate scripts in other ways, too.
For example, if you notice that a single prescriber tends to write considerably more prescriptions than other prescribers, may indicate a fake prescription.
Another common sign is a patient taking depressants and stimulants simultaneously.
Other examples of suspicious patient behavior to look for:
- The patient returns too frequently. (For example, a prescription that should last a month in legitimate use is being refilled on a biweekly, weekly, or even a daily basis.)
- The patient presents prescriptions written in the names of other people
- A number of people appear simultaneously, or within a short time, all bearing similar prescriptions from the same physician
- People who aren’t regular patrons or residents of the community show up with prescriptions from the same physician
Your pharmacy plays a huge role in preventing opioid misuse. Talk to your patients about opioids and keep your eye out for suspicious signs.
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