title: Pharmacists' experiences with dispensing opioids: provincial survey.
abstract: OBJECTIVE
  To explore pharmacists' beliefs, practices, and experiences regarding opioid dispensing.
  
  
  METHODS
  Mailed survey.
  
  
  METHODS
  The province of Ontario.
  
  
  METHODS
  A total of 1011 pharmacists selected from the Ontario College of Pharmacists' registration list.
  
  
  METHODS
  Pharmacists' experiences with opioid-related adverse events (intoxication and aberrant drug-related behaviour) and their interactions with physicians.
  
  
  RESULTS
  A total of 652 pharmacists returned the survey, for a response rate of 64%. Most (86%) reported that they were concerned about several or many of their patients who were taking opioids; 36% reported that at least 1 patient was intoxicated from opioids while visiting their pharmacies within the past year. Reasons for opioid intoxication included the patient taking more than prescribed (84%), the patient using alcohol or sedating drugs along with the opioid (69.9%), or the prescribed dose being too high (34%). Participants' most common concerns in the 3 months before the survey were patients coming in early for prescription refills, suspected double-doctoring, and requests for replacement doses for lost medication (reported frequently by 39%, 12%, and 16% of respondents, respectively). Pharmacists were concerned about physician practices, such as prescribing benzodiazepines along with opioids. Pharmacists reported difficulty in reaching physicians directly by telephone (43%), and indicated that physicians frequently did not return their calls promptly (28%). The strategies rated as most helpful for improving opioid dispensing were a provincial prescription database and opioid prescribing guidelines.
  
  
  CONCLUSIONS
  Pharmacists commonly observe opioid intoxication and aberrant drug-related behaviour in their patients but have difficulty communicating their concerns to physicians. System-wide strategies are urgently needed to improve the safety of opioid prescribing and to enhance communication between physicians and pharmacists.
authors.affiliation: Addiction Medicine Services Clinic, St Joseph's Health Centre, Toronto, ON. kahanm@stjoe.on.ca
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.forename: Lynn
authors.initials: L
authors.lastname: Wilson
authors.forename: Elizabeth Francis
authors.initials: EF
authors.lastname: Wenghofer
authors.forename: Anita
authors.initials: A
authors.lastname: Srivastava
authors.forename: Anne
authors.initials: A
authors.lastname: Resnick
authors.forename: Eva
authors.initials: E
authors.lastname: Janecek
authors.forename: Carolynn
authors.initials: C
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000506:poisoning / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy; D003061:Codeine / Q000506:poisoning / Q000627:therapeutic use; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D058999:Drug-Seeking Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D004091:Hydromorphone / Q000506:poisoning / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009864:Ontario; D010098:Oxycodone / Q000506:poisoning / Q000627:therapeutic use; D010595:Pharmacists / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010098:Oxycodone; D004091:Hydromorphone; D003061:Codeine
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