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Pharmacists say monitoring has curtailed opioid epidemic

Tahlequah Daily Press - 12/18/2019

Dec. 18--The impact of the opioid epidemic has been felt by people across the country, with thousands dying over recent years and communities flooded with prescription pain medication.

According to a database maintained by the Drug Enforcement Administration, which was released this year by the Washington Post, more than 76 billion oxycodone and hydrocodone pills were distributed across the country between 2006 and 2012. In that time, nearly 100,000 people died from opioid use. The Centers for Disease Control and Prevention states more than 70,000 people died from drug overdose in 2017, 68 percent of which involved a prescription or illicit opioid.

Cherokee County has not avoided the onslaught of medication funneled to communities, as more than 18 million pain pills -- at least 56 per person -- were supplied here between 2006 and 2012. However, pharmacists in town believe there's been improvement in oversight of patients and caregivers to combat overprescribing.

"At the moment, the medical board and the state law have some things in place to help prevent all of that," said Matt Lee, pharmacist at Tahlequah Drug Co. "The first thing we have to check is what's called the PMP -- prescription monitoring program."

The PMP is a database that allows pharmacists to look at a patient's prescription history and determine what doctors they've seen and what other pharmacies they've been to. Doctors are also responsible for checking the PMP system.

"As of right now, if a patient has an acute injury or they need some kind of acute pain relief, a prescription is only allowed to be filled for a seven-day supply," said Lee. "So that law in itself has helped curtail a lot of the overprescribing, because used to, if you had just a minor knee surgery, a doctor would write you a 30-day supply of some kind of pain medication though you only may need three days' worth."

The only ways for patients to receive 30-day supplies of prescription opioids is if they've been seen by a doctor three times.

If a patient still has pain after the third doctor visit, he can be prescribed more pills.

Darren Ward, pharmacist at Cherokee Hills Discount Pharmacy, said the opioid epidemic is serious, but he believes the problem is subsiding.

"Between the doctors policing and our policing, I would say that it's drastically reduced any of that," said Ward. "Probably the problem in the past would have been patients that utilize multiple doctors to try to obtain them and then go to multiple pharmacies. Well, the database has cut that out a lot. It's almost nonexistent -- at least from my perspective."

According to the DEA database, more than 1.4 billion prescription pain pills were supplied to Oklahoma between 2006 and 2012. Langsham Health Services LLC, in Oklahoma City, received more than 10 million pills. In Cherokee County, Tahlequah Medical Center Pharmacy received the most pills, with 3.23 million; Cherokee Hills received 2.71 million; Walmart Pharmacy, 2.69 million pills; Tahlequah Drug Co., 1.77 million; and Walgreen Co., 1.69 million. Reasor's Pharmay was not mentioned in the survey.

"I think this would be a little bit more difficult in a big city," said Ward. "In our little town, it's a lot easier to monitor the flow of prescriptions and patients. I would not fill any out-of-town scripts, for example, unless they were just a short, acute pain situation for a small quantity, where I knew they just came from a surgeon who just did knee surgery or something of that nature."

It does not take long for an individual to become addicted to opioids. A month or two-month supply of pain medication can cause a patient to become dependent. That makes it more difficult for doctors and pharmacists to reject a patient's request, but Ward said it's the best way to deal with the situation.

"That's the best way to do it and to stop this epidemic, because it's gotten very bad," he said. "There's no easy way or solution for a lot of these folks that have been on it for a very long time, to try to explain it to them that you probably don't need this much medication."

The county, state and country still have work to do, though. According to Dr. Julie Croff, executive director for the Center for Wellness & Recovery at the Oklahoma State University Center for Health Sciences, the most recent data from the office of Injury Prevention at the State Department of Health, Cherokee County has the second-highest level of 10 mg hydrocodone equivalents dispensed per person in the state, at 236 pills per person.

Oklahoma Attorney General Mike Hunter recently called on Congress to take action on legislation that would help law enforcement agencies and courts keep fentanyl off the streets.

"Fentanyl should only be used when prescribed and closely monitored by a doctor," Hunter said.

"Simply put, illicit fentanyl kills. Entire communities are being devastated across the United States because of its rise. Passing this bill will give the law enforcement community clarity as they continue working to curb the production and distribution of fentanyl-related substances. My colleagues and I look forward to the swift passage of the FIGHT Fentanyl Act by Congress."

Linda Vise, district nursing manager for the Oklahoma State Department of Health, forwarded media inquiries to the injury prevention department, which could not be reached by press time.

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