Opioid Misuse Remains a Priority

Opioid Misuse Remains a Priority

Opioid misuse remains a priority and an area of focus for the OctariusRx team. A recent report from the Kaiser Family Foundation ranked states by the number of people age 12 or older who reported opioid misuse. There are many variables that lead to inappropriate use. Do you know where your state ranks? Do you know what steps to take to minimize the risk? In this post we will discuss some steps you can take to make your patients safer and reduce your liability.

Whether it’s a facility with thousands of doses, or a patient at home with a smaller number of tablets, we all have a duty to properly use opioid medications. Opioid stewardship, much like antibiotic stewardship, requires having systems in place to ensure the medications are used only when absolutely necessary. Additionally, there are steps required for proper storage and disposal of these controlled substances. A facility that is lacking a system or an expert consultant pharmacist to help them implement and oversee processes, runs a greater risk of diversion and misuse.

So where does your state rank? Alabama and Oregon are tied for the highest rate of opioid misuse with Kentucky, Colorado, Kansas, Montana, Washington, Alaska, District of Columbia, and Iowa rounding out the top ten states. States with the lowest rates include New Hampshire, New Jersey, Rhode Island, Massachusetts, West Virginia, New York, Wyoming, Illinois, Nebraska and South Dakota. You can access the complete Kaiser Family Foundation data on Individuals Reporting Past Year Opioid Misuse for a complete list of states and their ranking.

Five ways facilities can minimize opioid misuse:

  1. Proper planning for management of post-operative pain: Long gone are the days when patients are prescribed large quantities of opioids for any given procedure. In the last decade we have seen the misuse and abuse potential of opioid medications in what we now recognize as a national crisis. Although there are times when opioids are the best option, it’s important to consider other options, both pharmacological, as well as non-pharmacological before writing that prescription. If an opioid is the best option, the next step is determining how much is necessary. Minimizing quantities and providing proper patient education are two good ways to reduce risks. Follow the Centers for Disease Control and Prevention’s (CDC) guidelines for prescribing for post-surgical pain. There are also strategies that can be implemented pre and peri-operatively to minimize the need for opioids after the procedure. Your pharmacy consultant can help you here.
  2. Proper storage: How does your facility store controlled substances? There are both federal and state requirements to be fully compliant. Each state has slightly different requirements, so make sure to check with your consultant pharmacist to ensure you are following the correct guidance. If you’re still unsure, give us a call and we can give a step-by-step process specific for your state.
  3. Proper disposal: How is your facility disposing of controlled substances? Did you know there is a difference between “wasting” and “destruction”? Wasting of partial doses is something that happens multiple times a day. Develop and implement a system to allow proper documentation of all discarded doses. Ensure wasting of controlled substances is carried out by two licensed staff and always done in “real time”. Destruction, on the other hand, is something that requires the use of a Drug Enforcement Agency (DEA) approved reverse distributor. If you’ve never used one or don’t know what one is, don’t panic, we can do a quick audit and determine what steps you need to take to be fully compliant with all the DEA requirements.
  4. Have a proper documentation trail: This is where so much can go wrong. Ensuring your system is comprehensive can go a long way to minimizing the risk of diversion. Facilities are encouraged to use a system that shows a complete trail from the time the medication enters your facility to the time it leaves. There is generally only one way into the facility, but there are various ways out. Was it administered to the patient, was it partially administered and partially “wasted”, did the vial or ampule break and result in waste, or did it expire? Your consultant pharmacist should be able to assess properly your system and give guidance on making it as “fool-proof” as possible. Remember, the goal is to recognize any discrepancy as quickly as possible to reduce the risks and facility liability.
  5. Frequent audits: Does your facility audit your controlled medication management system? Yes, you are performing the twice daily required counts, but this is not an audit of the complete system. You should have a process by which your entire routine is audited. This can be tedious and is not a fun task, but it is essential to finding areas of weakness and reducing risks. Controlled substance management is something I consistently advocate for and during each visit to my facilities, I take the opportunity to audit and assess the entire process. If your consultant pharmacist is just looking at the log, they are only completing part of this audit. You can do this yourself to supplement, but you should use an expert with an objective view to make sure you’re staying on track.

Whether your state is at the top or the bottom of the list, you have a duty to do everything possible to minimize the misuse of opioids. There are many steps each facility can take to improve patient outcomes and reduce the risk of opioid misuse. The items on this list are a good starting point, but they don’t replace having a highly qualified pharmacist to develop and monitor a controlled substance management system. It may seem extremely complex and there are definitely nuances when it comes to complying with Federal and state law. If you’re working with a specialized consultant pharmacist, they should be able to guide you through this process. If you have questions or are not currently working with a pharmacy consultant, we would love to hear from you.


The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centerssenior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.


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