Chiu Clever, Wong Anthony, Chhen James, Roderos Alfred-John A J, Apollonio Dorie E
School of Pharmacy, University of California San Francisco, San Francisco, California, USA.
Drug Alcohol Depend Rep. 2023 Nov 2;9:100199. doi: 10.1016/j.dadr.2023.100199. eCollection 2023 Dec.
Lawsuits have determined that community pharmacy chains played a crucial role in the opioid epidemic. However, little research has assessed community pharmacy practices. This study sought to understand the contribution of pharmacies to the opioid epidemic through improper opioid prescription dispensing.
We conducted an observational, retrospective content analysis that assessed the opioid dispensing practices of a retail community pharmacy chain, Walgreens, using pharmaceutical industry documents released in litigation between 1997 and 2020. The documents were retrieved from the Opioids Industry Document Archive (OIDA) at the University of California, San Francisco and reviewed to identify themes and identify organizational practices.
We identified four primary factors that may have contributed to improper opioid dispensing practices: store-level procedures, management pressure, distribution center activities, and pharmaceutical company sponsorship. Stores dispensed opioid prescriptions without resolving red flags, management pressured pharmacists to fill more opioid prescriptions, distribution centers failed to investigate high volume orders, and pharmaceutical companies sponsored pharmacist continuing education advocating for opioid pain management.
Our findings suggest that Walgreens may have contributed to the early prescription opioid epidemic through improper opioid dispensing and also identify key practices that could be reformed to reduce the risk of future inappropriate dispensing of addictive and potentially harmful medications.
诉讼已判定社区连锁药店在阿片类药物泛滥中起到了关键作用。然而，很少有研究评估社区药店的做法。本研究旨在通过不当的阿片类药物处方配药来了解药店对阿片类药物泛滥的影响。
我们进行了一项观察性回顾性内容分析，利用1997年至2020年诉讼中公布的制药行业文件，评估零售社区连锁药店沃尔格林的阿片类药物配药做法。这些文件从加州大学旧金山分校的阿片类药物行业文件档案库（OIDA）中检索，并进行审查以确定主题和识别组织做法。
我们确定了可能导致不当阿片类药物配药做法的四个主要因素：门店层面的程序、管理层压力、配送中心活动和制药公司赞助。门店在未解决警示信号的情况下配给阿片类药物处方，管理层向药剂师施压以开出更多阿片类药物处方，配送中心未能调查高批量订单，制药公司赞助倡导阿片类药物疼痛管理的药剂师继续教育。
我们的研究结果表明，沃尔格林可能通过不当的阿片类药物配药促成了早期处方阿片类药物泛滥，同时也确定了可以改革的关键做法，以降低未来不当配给成瘾性和潜在有害药物的风险。
