Pharmacists Play Big Role in More-Restrictive IHS Opioid Prescribing Rules

By Annette M. Boyle

Indian Health Service pharmacies must now check state Prescription Drug Monitoring Program (PDMP) databases whenever they dispense a prescription for opioids for more than seven days and periodically throughout chronic pain treatment. In this photo,  Spc. Darren Fields, pharmacy technician with the 256th Combat Support Hospital, 307th Medical Support Brigade, 807th Medical Command (Deployment Support), prepares to count pills and fill prescriptions during an Innovative Readiness Training mission at the Northern Cheyenne Community Health Center in Lame Deer, MT. Army Photo by Sgt. 1st Class Stan Maszczak

Indian Health Service pharmacies must now check state Prescription Drug Monitoring Program (PDMP) databases whenever they dispense a prescription for opioids for more than seven days and periodically throughout chronic pain treatment. In this photo, Spc. Darren Fields, pharmacy technician with the 256th Combat Support Hospital, 307th Medical Support Brigade, 807th Medical Command (Deployment Support), prepares to count pills and fill prescriptions during an Innovative Readiness Training mission at the Northern Cheyenne Community Health Center in Lame Deer, MT. Army Photo by Sgt. 1st Class Stan Maszczak

ROCKVILLE, MD—This summer, the Indian Health Service (IHS) instituted new rules for pharmacists and providers designed to reduce abuse and overuse of opioids, making it one of the first agencies to directly address the burgeoning rates of addiction and death associated with narcotic medications.

Pharmacists now must check state Prescription Drug Monitoring Program (PDMP) databases whenever they dispense a prescription for opioids for more than seven days and periodically throughout chronic pain treatment.

“Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs,” explained Leonda Levchuk, an IHS spokesperson.

The rate of drug-related deaths among American Indians and Alaska Natives has increased dramatically in recent decades, rising from five per 100,000 population in 1989-1991 to 22.7 per 100,000 in 2007-2009, Mary Smith, IHS principal deputy director, said in announcing the new policy. That puts drug-related deaths among American Indians and Alaska Natives at nearly twice the rate of the general U.S. population, which was 12.6 per 100,000 population among all races in 2007-2009.

Deaths from prescription opioid overdose have risen nearly 400% among American Indian and Alaska Natives in the past 14 years. In 1999 the rate was 1.3 per 100,000. By 2013, it had reached 5.1 per 100,000, according to the national Centers for Disease Control and Prevention.

The IHS program is one of several initiatives announced by the U.S. Department of Health and Human Services (HHS). Deaths nationwide from drug overdoses now exceed the number of fatalities from car crashes, said HHS Secretary Sylvia Burwell in program materials. In 2013, 16,000 Americans died from prescription opioid overdoses and another 8,000 from heroin-related overdoses.

The HIS has developed mandatory training on effective opioid prescribing for all of its pharmacists, as well as the agency’s 1,200 prescribers, Levchuk said.

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