A POCKET BOOK GUIDE FOR
PHARMACISTS
BEST PRACTICES
OKLAHOMA PRESCRIPTION MONITORING PROGRAM
AUTHOR NOTE
This publication was made possible through a grant from the Center for State, Tribal, Local, Territorial Support grant, which is housed within the Center of Disease Control, to the Southern Plains Tribal Health Board under cooperative agreement NU38OT000265. The content of this document is the responsibility of the author and does not necessarily represent the official position of the CDC.
Correspondence concerning this publication should be addressed to Casey Ward-Freeman.
THANK YOU TO PHARMACISTS WORKING IN TRIBAL COMMUNITIES
Address
9705 S Broadway Ext, Suite 200, Oklahoma City, OK 73114 Email cward-freeman@spthb.org
Native Americans have a higher rate of death from opioid-related overdoses than the national average (Albuquerque Area Southwest Tribal Epidemiology Center, 2018). Although statistics and best practices are often presented with clinical language, the opioid epidemic can feel deeply personal and challenging. Tribal communities are working to address the opioid epidemic, and the Prescription Monitoring Program (PMP) is one tool they can use to do that. This pocketbook is intended to highlight PMP policies and best practices that are relevant to pharmacists working in tribal communities within Oklahoma, provide tips on managing concerns related to prescription medications through the PMP, and assist pharmacists in discussing PMP concerns with Native patients. We thank you for your continued commitment to fostering healthy Native communities.
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CONTENTS
1. PMP Overview
2. Detecting Potential Prescription Concerns with PMP
3. Addressing Concerns About the PMP Report with Patients
a. Talking to Patients about the PMP
b. Four steps to take when discussing a patient’s PMP and dispensing decisions
4. Additional Resources
5. References
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A POCKET BOOK GUIDE FOR PHARMACISTS
1 PMP Overview
Section 1: PMP Overview
The Oklahoma Bureau of Narcotics and Dangerous Drug Control oversees the Oklahoma PMP. It monitors the dispensation of Schedule II–V controlled medications and is an important resource for addressing the opioid epidemic in Indian Country.
The Indian Health Service (IHS) policies and individual state laws related to PMPs provide ways to assess best practices. Pharmacists have two important roles regarding the PMP:
1. Pharmacists, or their designated delegates, should check the PMP before dispensing Schedule II–V controlled medications. The designated delegates should have their own PMP accounts registered under the dispenser. According to IHS (2020) policy, the pharmacist should check the PMP before:
a. Dispensing an outside prescription for a controlled substance
b. At least every 3 months
before reissuing or refilling for a chronic controlled substance prescription for Schedule II–V controlled medications for existing patients.
2. Pharmacists, or their designated delegates (with their own PMP system logins), should record the dispensation of Schedule II–IV controlled medications. Oklahoma law states that this should be done within 5 min of dispensation (Oklahoma Bureau of Narcotics and Dangerous Drug Control, 2020). IHS (2020) states that dispensing data should be reported at the frequency requested by the state.
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A POCKET BOOK GUIDE FOR PHARMACISTS
2 Detecting Potential Prescription Concerns
With the PMP
Section 2: Detecting Potential Prescription Concerns With the PMP
For pharmacists, checking the PMP can help note concerns such as:
• early refills
• multiple providers
• multiple pharmacies
• multiple prescriptions
• altered prescriptions
• an extended duration (i.e., over 7 days) opioid prescription for acute pain
• dangerous medication combinations (e.g., overlapping benzodiazepine and opioid prescriptions)
Identifying these factors can help enhance patient safety and lead to better health outcomes. (CDC, n.d., 2021). The Resources section contains links to more information about chronic pain management, safer opioid prescribing, and substance use disorders.
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A POCKET BOOK GUIDE FOR PHARMACISTS
3 Detecting Potential Prescription Concerns
With the PMP
Section 3: Addressing Concerns About the PMP Report With Patients
If a patient’s PMP report is concerning to the pharmacist and/ or their designated delegate, the pharmacist should do the following:
• discuss it with the prescriber to address concerns,
• discuss their concerns directly with the patient, and ultimately,
• decide whether to fill and dispense the medication (Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing [RESPOND], n.d.).
TALKING TO PATIENTS ABOUT THE PMP
Talking to patients about their PMP report, your concerns, and your clinical decision related to their prescription can be difficult, There are five main considerations to keep in mind when discussing your concerns with a patient:
1. Introduce yourself to the patient.
2. Let the patient know you have reviewed their PMP report and prescription history. Some patients may not know what the PMP is, and they may be surprised when it is mentioned.
3. Center the conversation around the patient’s safety and health.
4. Be respectful by using nonjudgmental and supportive language.
5. Inform the patient of your next steps and predicted timeline (RESPOND, n.d.).
When having these difficult conversations, remember to:
• Allow plenty of time to discuss concerns with the patient.
• Patients may be able to communicate their situations more effectively through storytelling.
• Remember that the patient may be in physical, spiritual, or mental pain (Jimenez et al., 2011)
• Ask open-ended questions to help build trust and collaboration.
• Use active listening
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techniques. Let the patient know they are being heard.
• Thank the patient for sharing their experiences.
• If met with anger or hostility, recenter the conversation on patient safety.
• Focus on the facts.
Follow this example: “Having multiple opioid prescriptions means that you are at a higher risk of overdose. My priority is your wellbeing and safety” (RESPOND, n.d.).
If possible, try to end the conversation with positive language (RESPOND, n.d.). See the following pages for examples.
FOUR STEPS TO TAKE WHEN DISCUSSING A PATIENT’S PMP AND DISPENSING DECISIONS
1. Introduce and inform
◦ “Hi, my name is Kasey, and I am a pharmacist here. It’s nice to see you. I have checked your prescription history using the Prescription Monitoring Program, or the PMP. Have you heard of the PMP?”
◦ Tip: Start building a foundation of support here (example: “It seems like you haven’t heard about the PMP. This is common. Would you like more information about it?”).
2. Be respectful and safety-centered
◦ “I am concerned that a couple of your prescriptions could be harmful when taken together. Are you having difficulty treating your pain?”
3. Allow time for discussion
◦ “Thank you for sharing. It sounds like you’ve had a difficult time finding a
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treatment for your pain. What concerns do you have about adding (more) pain pills to your current medications/ treatment strategies?”
◦ Tip: Use active listening here. Try phrases such as “It sounds like . . .” or “I get the sense that . . .”
4. Affirmation and next steps
◦ “The fact that you have those concerns really shows that you are committed to your health. We’re going to hold off on filling your prescription
at this time. I am going to talk to your provider today to recommend they review your prescription history and consider an alternative way to manage your pain.”
Note. Adapted from “Pharmacy PDMP Toolkit,” by Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing, n.d., PowerPoint slides.
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5
References
References
Albuquerque Area Southwest Tribal Epidemiology Center. (2018). The opioid crisis impact on Native communities.
Centers for Disease Control and Prevention. (n.d.). Prescription drug monitoring programs (PDMPs).
Centers for Disease Control and Prevention. (2021). Prescription drug monitoring programs (PDMPS): What healthcare providers need to know.
Indian Health Service. (2020). Chapter 32— State prescription drug monitoring programs.
Jimenez, N., Garroutte, E., Kundu, A., Morales, L., & Buchwald, D. (2011). A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples. The Journal of Pain, 12(5), 511–522.
Oklahoma Bureau of Narcotic and Dangerous Drug Control. (2020). PMP statues and codes [PowerPoint slides].
Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing. (n.d.). Pharmacy PDMP toolkit [PowerPoint slides].
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