Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction

Abstract

This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).

Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice

“…5,29 There are several publications evaluating the involvement of a pharmacist and/or pharmacist recommendations on a palliative care and/or hospice team. [28][29][30][31][32][33][34][35][36] A large percentage of pharmacists' recommendations for clinical interventions are accepted within a team and/or by a physician. 32,34,36 Survey data also suggest that a pharmacist is well received by patients and healthcare providers and contributes to increased efficiency in a palliative care clinic.…”

Educational and Career Goals of Pharmacy Students Upon Graduation

“…[5][6][7][8][9][10] This change in the scope of pharmacy practice has been fueled, in part, by healthcare reform (eg, the implementation of the "medical home"). [11][12][13][14][15] Given the present workforce environment, full-time pharmacist employment postgraduation will continue to be more competitive. The study conducted at the School of Pharmacy-Boston at Massachusetts College of Pharmacy and Health Sciences (MCPHS) University attempted to ascertain to what extent PharmD students understood this challenge and were preparing to meet it.…”

Single-dose fentanyl sublingual spray for breakthrough cancer pain

“…All patients treated with opioids require careful monitoring of signs of misuse. Diversion is an important consideration among patients receiving palliative care in nursing facilities or from caregivers at home 42,45…”