For patients with opioid use disorder, medication-assisted treatment programs are a clinically effective approach.
In 2020, an estimated 2.7 million Americans aged 12 years or older had opioid use disorder (OUD).1 For these patients, medication-assisted treatment (MAT) programs are a clinically effective approach for treating OUD.
Patients in MAT programs are typically given an oral medication, like buprenorphine and naloxone (Suboxone; Indivior PLC), over a period that can range between a few months to many years. These patients remain under close supervision of a health care professional throughout this treatment period to support the patient not only through the treatment but also through OUD associated withdrawal symptoms and cravings. For patients in MAT programs, medication security is a risk, and the potential consequences of drug diversion are serious.
As pharmacists, we have a responsibility to educate patients and their families on the unintended consequences of failure to safeguard and secure prescription medications, especially for those in our MAT programs. Many patients being treated with medications for OUD (MOUD) live with vulnerable family members, including children and teens; others may bring their medication with them to their work. Still others may live in congregate care settings with non-family members who are in recovery themselves—all require consideration as to the risks of not safeguarding and securing MOUDs in each environment.
According to the Ohio Department of Health,2 2020 surpassed 2017 as the highest year for unintentional drug overdose deaths in Ohio, with 5017 deaths and an age-adjusted rate of 45.6 deaths per 100,000 population—a 3% increase over 2017 and a 25% increase over 2019. Children are especially susceptible to accidental ingestion, with data from Safe Kids Worldwide showing that one child goes to an emergency room for medicine poisoning every 8 minutes,3 and 3 out of 4 ER visits for medicine poisoning are due to kids getting into parents’ or grandparents’ medicine. Plus, the family medicine cabinet is frequently a source for teen drug abuse.
However, it has been shown that controlling access to dangerous prescription medication is 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 oral prescription medicine-related death rate by up to 1.4 deaths per million children under age of 5 years—a 45% reduction in the rate of fatalities.
At Lower Lights Christian Health Center in Columbus, Ohio, we have set up a program for safe storage and transportation of medications for our MAT program using locking prescription vials. Nearly 250 patients have their buprenorphine and naloxone strips dispensed into locking prescription vials, which require a 4-digit code aligned from top to bottom to open. Patients are required to bring the vial back each time and ongoing feedback is gathered from patients, prescribers, and pharmacists. This helps us increase compliance among patients and puts a measure in place that could prevent accidental ingestion, misuse, and pilfering—helping us improve the overall efficacy of the MAT program.
As part of the program, we ask patients, prescribers, and providers a series of questions on their experience with the locking prescription vials to evaluate their efficacy in medication safety. The responses we have received from this program are showing promising results, with patient feedback largely emphasizing that it is a great idea and with many surprised a similar solution hadn’t been identified before. More than 80% percent of patients have reported that their medications are more secure.5 Some patients and parents already had their own security measures in place and recognized the need for safe storage. One patient with 5 young children at home shared that the locking prescription vial gives reassurance that their “curious” kids are protected from dangerous medications.
Moreover, initial data shows that pharmacists didn’t notice a significant impact to normal workflow and found the encoding process manageable. Probation officers and sober living housing managers have reported a reduction in theft and loss of medication. In fact, 100% of providers surveyed were in support of using a locking prescription vial for controlled substances as a means of safe storage.5
In 2022, the program expanded from Columbus to rural Marysville, in nearby Union County due to its success. Union County is the only county in Ohio experimenting with medication security for MOUD treatment programs.
With this program and research, we hope to educate other pharmacists through patient feedback and testimonials on one option for restricting access to MOUD that could help prevent misuse and diversion.
About the Author
John Ahler, RPh, is the pharmacy director at Lower Lights Christian Health Center, a federally qualified health center, in Columbus, Ohio. He has more than 30 years of experience in the field of pharmaceuticals and has led operations at companies including 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 Health Statistics and Quality. Results from 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 an emergency room for medicine poisoning. Safe Kids 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. Increasing Compliance & Medication Safety by Using Locking 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/