US Pharm. 2011;36(5):4. 

Many seasoned retail pharmacists will tell you that they've developed a sixth sense over the years in spotting drug abusers who come into their store. Pharmacists can oftentimes identify these individuals immediately as they enter the pharmacy. Maybe it is something in their gait, or perhaps it is their expression when they hand over the prescription; or it could be that the prescription is misspelled or simply looks suspicious. And amazingly enough, things haven't changed very much over the years. The choice of abused drugs may have changed, but that deep-rooted feeling that something is wrong has not. Though it's been several decades since I worked behind the prescription counter in my own pharmacies, I know I had this ability to spot a potential drug abuser.  

What troubles me are two recent reports published in The Journal of the American Medical Association by addiction researchers at the University of Pennsylvania School of Medicine and the National Institute on Drug Abuse (NIDA) that show a dramatic increase in the use of opioid prescriptions, while prescriptions for NSAIDs have decreased. According to NIDA, there has been an almost threefold increase in opioid prescriptions in the past 20 years. This dramatic jump has created a bit of a dilemma for the pharmacists who believe they have that sixth sense about drug abusers: It has become more difficult to differentiate from patients who are simply abusing opioids from those who have legitimate chronic pain and take opioids on a regular basis for long-term pain management.  

Despite our best efforts as health care professionals, it appears that the widespread use of opioids has gotten out of control. A recent article in the Chicago Tribune talks about some of the challenges that physicians are facing in treating chronic pain. On the one hand, physicians are cognizant of patients who need medication for chronic pain and of the effectiveness of opioids in managing this pain. But they also are faced with the reality that opioids have many medical and behavioral side effects, most notably respiratory depression and addiction, respectively. According to the article, 11,499 people died from opioid overdoses in the United States in 2007. That was more than the number of overdose deaths for heroin and cocaine combined. The article claims that some doctors are asking their patients to sign a “pain contract” that lays out a game plan for taking strong narcotic drugs. These contracts may specify drug or blood tests and include agreements to get pain medication from no other physicians and to fill all pain medication prescriptions at one pharmacy. 

These are important guidelines for patients because the NIDA study uncovered that approximately 56% of painkiller medications were given to patients who had filled another prescription for pain from the same or a different provider in the same month. As pharmacists, I know many of you have “war stories” when it comes to drug abusers and doctor shoppers. In the final analysis, it is the pharmacist who can actually play a major role in helping to curtail the widespread abuse of narcotics. It is incumbent upon pharmacists to question their patients to make certain that they are not only taking all their medications properly but also--most important--that they are also taking their narcotic pain medications appropriately. In the end, it all amounts to proper management of medication therapy. Chronic pain sufferers need the relief, but in a controlled environment. Pharmacists are in the best position to provide that important service. 

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