SCOTT G. WEINER: Prescription drug monitoring programs
are very powerful databases that currently 49 states have implemented.
It's a pretty new thing.
They have just started in the past-- maybe five years or so for most states,
although a handful of states have had them for a couple of decades.
The new thing about this is that they are often web-based.
So as an emergency physician, I can see a patient.
If I'm considering giving them a medication, like an opioid,
I can log on to a state database.
And what it does is it tells me all of the controlled substance
prescriptions-- those are medications like benzodiazepines for anxiety,
or pain medications like opioids--
tells me every single prescription they've had in the state
and often in surrounding states now as well too.
This has been a game changer for us.
There's so-called doctor shopping, where patients go from hospital to hospital.
We don't like that term but that's often frequently what it's called.
And we've seen a marked decrease in that because
of the existence of prescription drug monitoring programs.
And the reason is that it becomes difficult to have multiple prescribers
for your medications.
So patients that go from emergency department to emergency department
and get different prescriptions now have difficulty with that, frankly,
and that's a good thing.
It's gotten to the point where initially we were really
advocating for them to be implemented, and now the government has
realized how powerful these are.
And in many states it's actually mandated.
So in the state of Massachusetts, for example,
if I want to prescribe a prescription-- if I want to prescribe an opioid,
I have to access the state prescription drug monitoring program at that point.
It's forced us to use it.
It's actually entered our workflow, which is a very good thing.
And probably the most powerful part about this
is that if I'm seeing a patient that has a profile that
has lots of prescriptions from lots of different providers, I print that out,
and I bring it to the bedside, and it starts a conversation.
Why do you have so many providers?
Why are you getting so many prescriptions?
And that can be a very powerful teachable moment.
SARAH O'NEILL: I think pharmacists play a very big role.
Number one because we're responsible for dispensing the opioids.
So the opioids have to come from somewhere.
And although many of them are found throughout a prescription,
usually they are obtained by someone who had a prescription from their doctor
and they got it at a pharmacy.
So it's our job as pharmacists to make sure that every prescription we fill
is for a legitimate medical purpose, and it's written by a doctor that
is practicing within their scope.
And so it is our job to prevent any prescriptions being filled that
shouldn't.
Basically having patients who are in pain, that need the medication, get
it, and the other patients that are potentially abusing the drug
or selling it, hopefully they wouldn't be getting it from the pharmacy.
We also help avoid the opioid crisis by maintaining
an accurate inventory in the pharmacy.
Make sure there's no diversion or stealing, as you would call it.
And if anyone calls and they ask, hey, how much oxycodone do you have?
We don't give them that information over the phone.
We keep very strict inventory.
So there's many ways, including making sure
that we check the prescription monitoring program and communicating
with doctors, if there's any patient that's
trying to fill prescriptions early, or anything
that seems out of the ordinary.
So there's many ways that I feel that we can
help continue to decrease the crisis.
Sometimes we're faced with a situation in the pharmacy
where we do not fill an opioid medication when
the patient brings the prescription, even though the doctor wrote it.
There are several reasons that this may occur.
One of the most common reasons is that it's too soon to fill it.
We have a very strict policy as far as when
you can feel your controlled substances to avoid anybody getting early refills.
So typically if you filled your prescription
for your controlled substance 30 days ago, basically,
we would never fill it sooner than 28 days from that time.
So we have to make sure not to fill any prescriptions early
that are controlled substances, and that's
the number one reason why we would deny a patient filling
a medication for a controlled substance.
Other reasons that we might not fill a prescription
is because of other red flags that we see in their profile.
They don't want to fill it through their insurance,
for example, which is a red flag because everybody has insurance.
It's required.
And basically, if they're saying, I don't
want to pay for it with my insurance, they're
trying to avoid us seeing them getting another prescription, most likely
somewhere else, where did go through the insurance.
So in this case they're usually pharmacy shopping or doctor shopping.
And in this case, it's easy now for us to check on the prescription monitoring
program online and see where they filled their last prescription.
How many they got?
Are they do for a refill?
It's our job, basically, to make sure that if you have pain medication,
you get it when you're due to fill it.
Not too soon, not before it's due, but you should be taking as prescribed.
And in that case, you shouldn't need to get it early.
So if a patient tells me that they're out
because they were taking it differently than what the label said,
that concerns me and I immediately contact the doctor.
We play a big role in keeping the doctor in the loop
because a lot of information comes from the patient when
they're trying to get a prescription and it's, for instance, too soon
to be filled.
We can also not fill a prescription if after we talk to the doctor,
they say, hey, I didn't know that they had this other prescription.
They never told me.
Cancel the prescription.
So sometimes the doctors do in fact cancel the prescriptions
that they already wrote once they're informed about the other prescriptions
that they got.
These days, that's mostly avoided because they've already
seen before they wrote the prescription, by logging into the prescription
monitoring program, what they've got and the last time they got it.
So that issue doesn't really fall on the pharmacist anymore.
But sometimes it falls through the cracks
and a patient is using more than one doctor,
and maybe they're outside of the partners network.
And that's the situation where we don't feel comfortable
filling the prescription, but we keep the doctor in the loop as well.
The MedSafe program is, basically, a disposal unit
that sits outside the pharmacy at Mass General.
And it allows patients, at any time of day,
to come and drop off their medications.
Whether it has a label on it or it doesn't have a label,
they're not sure what it is, it doesn't matter as long as it's not a syringe.
Any type of tablet at all can be disposed here,
and it just gets incinerated.
And it's safely handled by our employees in the pharmacy.
We dispose of the box and then the MedSafe company incinerates it.
So they don't need to worry about their personal information being anywhere.
So it's very safe.
And here at Mass General, it's so popular
that we have to change out the unit about once a week.
So there's a lot of medications out there that are being dropped off.
So it's been a very effective form of drug take back.
Every week we have to replace the disposal unit.
And we send back about 50 pounds worth of drugs back to the company
to be incinerated, just to give you an idea
of how many drugs are actually dropped off every week here at the hospital.
It's a very significant amount, and it decreases
the number of tablets that are out in people's
homes and available for basically use.
And it could be controls and non-controls.
So it's not just controlled substances that are going in there.
It's any type of old, expired, unused medication.