Challenges faced with opioid prescriptions in the community setting - Australian pharmacists' perspectives

Abstract

Background: Prescription opioids (POs) are well recognised for their role in pain management. However over recent years, use of POs has become an increasingly complex public health issue, with the emergence of increasing quantities of POs being misused and abused. Pharmacists represent the 'gatekeepers' of medicines, which can be a challenging role, relating in particular to POs.

Objective: This study aimed to gain insight into the challenges Australian community pharmacists experience in the dispensation of POs.

Setting: Sydney Australia.

Method: Twenty-five pharmacists were recruited from suburbs in and around Sydney, Australia. Pharmacists were interviewed using an in-depth, semi-structured protocol. All interviews were audio-recorded, transcribed and thematically analysed.

Main outcome measure: Identification of issues/factors that may influence the dispensing of POs.

Results: Pharmacists were reportedly confronted with several issues in the dispensing of POs, particularly in relation to the patient and prescriber. Pharmacists reported some individuals becoming increasingly more "creative" in the methods used to obtain POs, rendering detection of potential abuse/misuse increasingly difficult. Poor professional relationships with prescribers-an apparent power dynamic between the two professions, and limited engagement with patients were issues also identified. The majority of participants suggested that an electronic monitoring database would help in the identification of PO abuse/misuse.

Conclusion: Education is required to emphasise the importance of inter-professional collaboration between pharmacists and prescribers, as is empathy in the pharmacist-patient relationship. Prescription drug monitoring programs and prescribers sending electronic prescriptions directly to the pharmacist were perceived as helpful initiatives to undertake.

Keywords: Challenges; Culture; Intervention; Perspectives; Pharmacist; Prescription opioids.