For patients with opioid use disorders, drug treatment programs are a clinically effective approach.
In 2020, approximately 2.7 million Americans age 12 or older had opioid use disorder (OUD).1 For these patients, drug treatment programs (MAT) are a clinically effective approach to treating TOU.
Patients in MAT programs typically receive oral medication, such as buprenorphine and naloxone (Suboxone; Indivior PLC), over a period of months to years. These patients remain under the close supervision of a medical professional throughout this treatment period to support the patient not only throughout treatment, but also through the withdrawal symptoms and cravings associated with OUD. . For patients in MAT programs, drug safety is a risk and the potential consequences of drug diversion are serious.
As pharmacists, we have a responsibility to educate patients and their families about the unintended consequences of failing to safeguard and secure prescription medications, especially those in our MAT programs. Many patients treated with drugs for OUD (MOUD) live with vulnerable family members, including children and adolescents; others may bring their medications with them to work. Still others may live in congregate care settings with non-family members who are themselves in recovery – all must be considered as to the risks of not protecting and securing MOUDs in each environment .
According to the Ohio Department of Health,2 2020 surpassed 2017 as the highest year for accidental drug overdose deaths in Ohio, with 5,017 deaths and an age-adjusted rate of 45.6 deaths per 100,000 population, an increase of 3% from 2017 and 25% from 2019. Children are particularly susceptible to accidental ingestion, with data from Safe Kids Worldwide showing that a child visits the emergency room for drug poisoning every 8 minutes,3 and 3 out of 4 emergency room visits for drug poisoning are due to children entering the medicine of their parents or grandparents. In addition, the family medicine cabinet is often a source of drug abuse among adolescents.
However, controlling access to unsafe prescription drugs has been shown to be a useful intervention in injury prevention settings. For example, after the enactment of the Poison Prevention Packaging Act (PPPA) in 1970, the Consumer Product Safety Commission (CPSC)4 reported that child-resistant packaging reduced the death rate from oral prescription drugs by up to to 1.4 deaths per million children under 5 – a 45% reduction in the death rate.
At Lower Lights Christian Health Center in Columbus, Ohio, we have implemented a secure medication storage and transport program for our MAT program using lockable prescription bottles. Nearly 250 patients have their buprenorphine and naloxone strips dispensed in lockable prescription bottles, which require a 4-digit code lined up from top to bottom to open. Patients are required to return the vial each time and ongoing feedback is collected from patients, prescribers and pharmacists. This helps us increase patient compliance and puts in place a measure that could prevent accidental ingestion, abuse, and theft, which helps us improve the overall effectiveness of the MAT program.
As part of the program, we ask patients, prescribers, and providers a series of questions about their experience with locking prescription bottles to assess their effectiveness in medication safety. The responses we have received from this program show promising results, with patient feedback widely emphasizing that it is a great idea and surprisingly a similar solution had not been identified before. Over 80% of patients said their medications are safer.5 Some patients and parents had already implemented their own safety measures and recognized the need for safe storage. A patient with 5 young children at home shared that the lockable prescription bottle reassures their “curious” children are protected from dangerous drugs.
Additionally, initial data shows that pharmacists did not notice a significant impact on normal workflow and found the encoding process manageable. Probation officers and sober housing managers have reported a reduction in theft and loss of medication. In fact, 100% of providers surveyed supported the use of a lockable prescription bottle for controlled substances as a safe storage method.5
In 2022, the program expanded from Columbus to rural Marysville in neighboring Union County due to its success. Union County is the only county in Ohio to experiment with drug safety for MOUD treatment programs.
Through this program and research, we hope to educate other pharmacists through patient feedback and testimonials on an option to restrict access to MOUD that could help prevent abuse and diversion.
About the Author
John Ahler, RPh, is the director of pharmacy at Lower Lights Christian Health Center, a federally licensed health center, in Columbus, Ohio. He has over 30 years of pharmaceutical experience and has led operations at companies such as CVS Health and Medco Health Solutions. John earned a Bachelor of Science in Pharmaceutical and Biomedical Sciences from Ohio Northern University.
- Addiction Center for Behavioral Health Statistics and Quality. Results of the 2020 National Drug Use and Health Survey: detailed tables. SAMHSA. Published October 25, 2021. Accessed October 25, 2022. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
- 2020 Ohio Drug Overdose Report. Ohio Department of Health. Accessed October 17, 2022. https://odh.ohio.gov/know-our-programs/violence-injury-prevention-program/media/2020+ohio+drug+overdose+report.
- Every 8 minutes, a child goes to the emergency room for drug poisoning. Safe Kids in the world. Published March 12, 2014. Accessed October 17, 2022. https://www.safekids.org/press-release/every-8-minutes-child-goes-emergency-room-medicine-poisoning
- US Consumer Product Safety Commission. 2005. Accessed October 17, 2022. https://www.cpsc.gov/safety-education/safety-guides/containers-and-packaging/poison-prevention-packaging-guide-healthcare.
- Ahler J. Increasing medication compliance and safety by using locking prescription bottles in a medication-assisted treatment (MAT) program. Lower Lights Christian Health Center. Accessed November 8, 2022. https://llchc.org/health-services/addiction-treatment/
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