Pharmacists and Pharmacies

Standards for pharmacies to carry and dispense opioids would also assist in improving accessibility to pain therapy for those who need it. Pharmacist-physician collaboration in chronic pain therapy is necessary to prevent diversion and abuse, as well as to ensure adequate pain management of the individual patient. Specialty pharmacies for scheduled drugs may be helpful in ensuring that diversion and abuse prevention is occurring during medication dispensing. These pharmacies may also relieve patient difficulties in getting their opioid prescriptions filled at general pharmacies loathe to handling these prescriptions.

These specialty pharmacies would, however, need to be ubiquitous enough for patient convenience, especially in areas where patient transportation is at issue. The specialty pharmacy could be useful in minority communities where currently there are insufficient numbers of pharmacies carrying adequate opioid medications to treat severe pain. The pain specialty pharmacy would allow for greater pharmacist-physician collaboration and therefore better monitoring for abuse, misuse, and diversion of opioid medication. The pain specialty pharmacy would also have the opportunity for greater collaboration with the DEA in prevention of diversion of opioid medication. Although always under the watchful eye of the DEA, closer cooperation with the DEA may allay specialty pharmacies' unfounded fears of DEA investigation. Unfortunately, the pain specialty pharmacy would also likely require heightened security because of the risk of medication theft and may find its clientele stigmatized because of the prevailing opiophobia. While the specialty pharmacy may be a useful adjunct in the war on pain, its presence should not be seen as usurping the responsibility of general pharmacies to provide their clientele with adequate stocks of opioid medications.

Pharmacy legislation may also ameliorate pharmacy opioid stock issues. State legislatures could mandate that pharmacies stock adequate opioid medications to even out the disparity between white and minority community pharmacies. Federal legislation could also connect Medicare Part D pharmacy reimbursement to maintaining adequate opioid stocks. Third party payor reimbursement is a powerful incentive to pharmacies and would likely be an effective means of increasing pharmacy opioid stocks.