ORLANDO – Pharmacists who dispense in the community tend to be skeptical about patients who require chronic medication with controlled substances, according to a survey of pharmacists practicing in both urban and rural areas of Alabama.
The survey revealed that many pharmacists have serious misconceptions about chronic pain patients and the way physicians prescribe medications to manage their pain, Karen F. Marlowe, Pharm.D., of the University of South Alabama Medical Center, Mobile, said at the annual clinical meeting of the American Academy of Pain Management.
Dr. Marlowe sent a 40-question survey to 150 pharmacists who dispensed in two counties between December 2005 and February 2006. Seventy-eight surveys were returned: slightly more than half of responders (53%) were female, and 25% worked in chain drugstores, 25% in independent pharmacies, 20% in hospitals, 16% in “big box” or superstores, and 14% in grocery stores.
For most of the respondents, pain medication, including NSAIDs represented 25% of their daily prescription volume.
The pharmacists' main concern was for their compliance with controlled substance regulations. Most considered their knowledge of pain management and controlled substances good or excellent.
None felt they had received inadequate education about pain medications in pharmacy school. That response was something of a surprise to Dr. Marlowe. “I have looked at what is included in pharmacy school [curricula] in various parts of the country. Pharmacy schools on the West Coast have better pain [curricula] than do pharmacy schools on the East Coast. I graduated from Auburn University in 1995, and I got just 1 day … out of 4 years to learn about choosing and monitoring pain therapy.”
Two of the survey's most interesting findings were that pharmacists perceive early refills of pain medication as a sign of addiction and that the majority of pharmacists felt uncomfortable dispensing opiates. “These are serious misunderstandings, and we need to target them as areas for further education,” she said.
The survey also found that female pharmacists were more likely to dispense emergency supplies of controlled substances than male pharmacists (70% vs. 40%, respectively), while male pharmacists were more likely to agree with the statement that physicians overprescribe (males, 48%, vs. females, 35%). Also, 50% of pharmacists in practice longer than 15 years were more likely to contact a physician regarding pain medications and seek an opinion on early refills.
Dr. Marlowe said that she plans to conduct her survey nationwide. “We need to determine which issues need to be addressed. … We'll be able to look at who specifically needs to be educated [and whether] misconceptions [are] regional. Are they due to length of time out of school? Are they more prevalent in rural versus urban areas? In chain versus hospital pharmacies? The results will be interesting to see.”
Surveyed pharmacists perceived early refills of pain medication as a sign of addiction. DR. MARLOWE