Wide range of opioid solutions addressed in College of Pharmacy lecture event

Over the past decade, Missouri has been near the center of one of the nation's most pressing issues -- the opioid epidemic. The St. Louis College of Pharmacy, who hosted a lecture event at Port Cape Girardeau Tuesday, is looking to involve alumni of their school, as well as the public, into the conversation and pushback against bad prescribing practices.

Professors from the St. Louis College of Pharmacy shared their research with alumni and community members, on how to improve the role of the Pharmacist in a medical culture plagued by overdose death and addiction.

One speaker, Amy Tiemeier, associate professor and president of the not-for-profit organization Missouri Prescription Pill and Drug Disposal (P2D2), said of the pharmacist's role in addressing the opioid epidemic, there is more to be done.

Missouri became the last state to implement a Prescription Drug Monitoring Program in late April, 2017 and since, Tiemeier said more than 6,000 people have registered and 90 percent of prescribers have joined the program. But there are holes in Missouri's PDMP system, which operates county-by-county rather than statewide.

"From a providers perspective, either physician or pharmacist, if I want a full picture of what medication and controlled substances that a patient is taking, and they are getting a prescription filled elsewhere, I can't get the full picture," Tiemeier said in an interview before her lecture. "I can't provide the best care without all the pieces of data."

Legislation that would implement a statewide PDMP has been debated in Jefferson City for more than a decade and has repeatedly failed to move from the House floor.

"Representative Holly Rehder has been very proactive in bringing this up," Tiemeier said. "There's also some other legislators, one in particular, who is very opposed to this. It's thought to be an invasion of privacy and overreaching beyond what government should do, so that opposition has resonated with enough people that it hasn't passed, but it's back in the legislation again this year."

In a 2016 article in the St. Louis Post-Dispatch, Tiemeier called Missouri the "ground zero" for bad actors looking to obtain multiple prescriptions for potent and addictive medications from multiple doctors.

In an interview before her lecture, Tiemeier said that she knew from her connections with the Regional DEA office housed in St. Louis, that there had been interactions with people who were "doctor-shopping" or involved in "pill mills" who had come from states away.

"Certainly they didn't need to come this far to get that prescription filled, but knowing that there was that lack of oversight and potential information being passed along, then they would make the extra effort to come here to get their prescriptions filled," Tiemeier said.

The importance of medication take-back programs was another topic covered heavily at the STLCOP Talk Tuesday night.

The first of two National Take-Back Days, where the public can properly dispose of expired or unnecessary medications, will be held at local police stations April 28, 2018. Tiemeier said there is additional piece of state legislation that would also allow pharmacies to act as Take-Back locations. She noted that St. Louis already has around 30 medication disposal kiosks which create opportunity for safe and convenient disposal.

"If we can make sure that those controlled substances that aren't being used, are removed from homes and incinerated than that decreases the risk of diversion," Tiemeier said. "We are getting controlled substances out of homes where they could be diverted or misused or even accidentally poison kids and pets."

From Sept. 2015 to Oct. 2017, take-back programs removed 369,311 pounds of medication from Missouri homes -- a total that makes up half of a multistate district total of 776,144 pounds.

"A primary place that people go when they're first starting [to abuse prescription drugs] or needing to feed their addiction, unfortunately, is that they are stealing out of the homes of family members and friends," Tiemeier said.

Additionally, Tiemeier spoke on the importance of raising awareness in the pharmaceutical world of the distribution of Naloxone, a medication used to counter narcotic overdose in emergency situations.

In Aug. of last year, Director of Health and Senior Services Randall Williams put forth a standing order that makes Naloxone available to anyone in Missouri who is at risk of overdose or at risk of observing an overdose, in any pharmacy in the state. Tiemeier said she has been traveling widely to increase education and resources associated with the Medically Assisted Treatment.

Tiemeier said attention to mental health support and the support of social services, along with early education about proper use of medication, is crucial to actively addressing the issue.

"For people to successfully stay in recovery, they need a constellation of things: mental health support, social services support, all those things need to be in place including Medically Assisted Treatments, to help them have the best chance possible for longtime recovery," she said.

Tiemeier's St. Louis College of Pharmacy colleagues discussed additional modes of improvement in the pharmaceutical community.

Melanie Van Dyke, assistant professor of psychology, presented her recent and ongoing research on Medication Saving Behaviors (MSB) and medication hoarding. Van Dyke said that there has been very little research on the topic in the last decade and that most studies had used different definitions of the behavior. Her study established the first standardized measure on the topic.

Hoarding, Van Dyke said, was originally thought to be a symptom of Obsessive Compulsive Disorder, but has recently been recognized as a separate disorder. Her study looked specifically at the saving behaviors of women who help with the care of an older family member, in an attempt to find better ways to promote proper use of medications, as well as proper disposal.

"If we participate in drug disposal methods, we can reduce the risk," Van Dyke said. "There's a greater desire among professionals to educate the public on how to store medication and how to dispose of it."

Van Dyke said her future research will look to find patterns in health outcomes and the occurrence of adverse side-effects in relation to Medication Saving Behaviors and prescription adherence.

The other speaker, assistant professor of pharmacy practice Ryan Moenster, discussed an ongoing study he has been conducting at the St. Louis Veteran's Home. His research centered around the prescribing practices and health outcomes of antibiotic medications, especially as outpatient treatments.

Moenster said often times, FDA approval of a drug is based on a shorter period of time than what it is being prescribed for, which can cause side effects. His research centers around effectiveness and health outcomes of prescription medications, as well as considering ways for patients to more efficiently benefit from hospital visits, by providing outpatient options that help to reduce costliness and avoid exposure to harmful bacteria.

The St. Louis College of Pharmacy Talk highlighted the economic burden of prescription drug misuse, citing $78.5 billion a year nationwide cause by opioids along. Additionally they highlighted the fact that the number of deaths from prescription opioids have more than quadrupled since 1999.

Tiemeier said the industry is now looking to all modes of treatment for pain management.

"[The industry] was coming up these drugs and advertising them at the same time we were trying to address pain," Tiemeier said. "Because we weren't doing a good job of treating pain in the medical community, so I think the pendulum swung from not treating well at all to probably over treating and now we're realizing the impacts of that."

For more information on the St. Louis College of Pharmacy Talks series visit https://www.stlcop.edu/admissions/visit/stlcop-talks.html

Pertinent address:

19 N Water St, Cape Girardeau