For patients with opioid use disorder, drug-assisted treatment programs are a clinically effective approach.
In 2020, an estimated 2.7 million Americans age 12 or older had an opioid use disorder (OLD).1 For these patients, drug-assisted treatment (MAT) programs are a clinically effective approach to treating OLD.
Patients in MAT programs are usually given oral medications, such as buprenorphine and naloxone (Suboxone; Indivior PLC), for a period of time that can range from a few months to many years. These patients will remain under the close supervision of a healthcare professional throughout this treatment period to support the patient not only during treatment, but also through withdrawal symptoms and cravings associated with OLD. For patients in MAT programs, medication safety is a risk, and the potential consequences of drug misuse are serious.
As pharmacists, we have a responsibility to educate patients and their families about the unintended consequences of failing to protect and secure prescription medications, especially for those in our MAT programs. Many patients treated with medications for OLD (MOUD) live with vulnerable family members, including children and teenagers; others can take their medication to work. Still others may be living in shared care settings with non-family members who are recovering themselves – all must consider the risks of not protecting and securing MOUDs in any setting.
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 residents – a 3% increase from 2017 and a 25% increase compared to 2019. Children are particularly susceptible to accidental ingestion, with data from Safe Kids Worldwide showing one child goes to an emergency room every 8 minutes for drug poisoning,3 and 3 out of 4 ER visits for drug poisoning are due to children getting into parents’ or grandparents’ medications. In addition, the family medicine cabinet is often a source for teenage drug abuse.
However, controlling access to dangerous prescription drugs has been shown to be a useful intervention in injury prevention circles. For example, after the Poison Prevention Packaging Act (PPPA) was signed into law in 1970, the Consumer Product Safety Commission (CPSC)4 reported that child-resistant packaging reduced the death rate associated with oral prescription drugs by up to 1.4 deaths per million children under 5 years old – a 45% reduction in fatalities.
At the Lower Lights Christian Health Center in Columbus, Ohio, we established a program for safe storage and transportation of medications for our MAT program using sealable prescription bottles. Nearly 250 patients have their buprenorphine and naloxone strips delivered in sealable prescription vials, which require a 4-digit code aligned top to bottom to open. Patients must return the vial every time and feedback is constantly collected from patients, prescribers and pharmacists. This helps us to increase patient compliance and to put in place a measure that can prevent accidental ingestion, misuse and theft, thereby improving the overall effectiveness of the MAT program.
As part of the program, we ask patients, prescribers and healthcare providers a series of questions about their experience with the sealable prescription bottles to evaluate their effectiveness in terms of medication safety. The feedback we’ve received on this program shows promising results, with patient feedback largely emphasizing that it’s a great idea and many surprised that a similar solution hadn’t been found before. More than 80% percent of patients reported that their medications are more secure.5 Some patients and parents had already taken their own safety precautions and recognized the need for secure storage. A patient with 5 young children at home shared that the sealable prescription bottle provides reassurance that their “curious” children are protected from dangerous drugs.
In addition, initial data show that pharmacists did not notice a significant impact on normal workflow and found the coding process manageable. Probation officers and sober-living housing managers report a decrease in theft and loss of medication. In fact, 100% of providers surveyed were in favor of using a closable controlled substance prescription bottle as a means of secure storage.5
In 2022, due to its success, the program expanded from Columbus to rural Marysville, in nearby Union County. Union County is the only county in Ohio to experiment with drug security for MOUD treatment programs.
With this program and research, we hope to educate other pharmacists through patient feedback and testimonials about one option to limit access to MOUD that can help prevent misuse and abuse.
About the author
John Ahler, R.P.h, is the pharmacy director of the Lower Lights Christian Health Center, a federally qualified health center, in Columbus, Ohio. He has more than 30 years of pharmaceutical experience and has led operations at companies such as CVS Health and Medco Health Solutions. John received a Bachelor of Science in Pharmaceutical and Biomedical Sciences from Ohio Northern University.
- Substance Abuse Center for Behavioral Statistics and Quality. Results of the 2020 National Survey on Drug Use and Health: 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 children worldwide. 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. Increase in compliance and medication safety by using lockable prescription vials in a medication-assisted treatment (MAT) program. Lower Lights Christian Health Center. Accessed November 8, 2022. https://llchc.org/health-services/addiction-treatment/