The New Battlefield of the War on Drugs

The people who prepare our prescriptions never asked to play police, but pharmacies are the last line of defense against prescription drug abuse. Don Bell helps them stay compliant and is training their employees to spot the clues that point to offenders

The Centers for Disease Control calls it an epidemic. After marijuana and alcohol, prescription drugs are the most abused substance by Americans 14 or older. They are among the easiest drugs for people to access and abuse because they can be, and usually are, bought legally. Prescription drug abuse has been identified as a major problem by everyone from local law enforcement agencies to the Office of National Drug Control Policy, and an emphasis on education and recognizing warning signs has been key in their battle against it.

What is often overlooked is the role played by the pharmacies that dispense the drugs in question. “The DEA (Drug Enforcement Administration) calls pharmacists the last line of defense against prescription drug abuse,” says attorney Don Bell, the senior vice president and general counsel for the National Association of Chain Drug Stores (NACDS). NACDS counts chain drug retailers, manufacturers, wholesalers, and suppliers among its members. NACDS takes many approaches to advocacy for its members, including legislative lobbying, litigation at the federal and state levels, and offering commentary on executive decisions. Education is a key component of every form of advocacy NACDS practices, and Bell considers his role as an educator an important extension of his title as an attorney.

That focus is especially crucial now. As the DEA promotes new methods to target prescription drug abuse, NACDS works to keep its members compliant and protected. Fifteen thousand people die each year from prescription drug overdose—more than heroin and cocaine combined, Bell says. Emergency room visits for prescription drug overdoses have doubled in the last five years, and “pill mills” have been popping up across the country. Pharmacists, he says, are seen as a stopgap.

One of the most obvious and problematic issues with battling prescription drug abuse is that most prescriptions are written for legitimate medical purposes. The DEA recognizes this and doesn’t expect pharmacists to play doctor, Bell says. But there are many “red flags” that the DEA believes pharmacists should be on the lookout for when filling prescriptions for controlled substances. There are a number of these flags, such as customers who want to pay in cash despite being covered by insurance, or doctors writing many prescriptions for commonly abused drugs. When these indicators are present, pharmacists are expected to note them, investigate, and resolve the issue before dispensing the controlled substance medications. If they can’t resolve it, they aren’t supposed to distribute the drug. This in itself is a difficulty, though; there are so many potential flags that it is often confusing to identify them and harder to resolve them. That’s what Bell and NACDS hope to change for their members.

In response to the DEA’s crackdown on distributors, many pharmacies are implementing stricter compliance programs and are writing processes to resolve problems. That involves a great deal of training for store personnel and pharmacists. “Pharmacies have really stepped up to create that internal compliance,” Bell notes.

Bell’s role in helping pharmacies stay compliant has two parts. The first is a series of one-on-one discussions with member companies in which he answers specific questions about the DEA’s requirements. His answers have helped these companies establish their programs, and Bell has advised their attorneys to create strategies and practices that target the problem without hampering the business.

The second part is to help create DEA requirement education tools. There are three programs aimed at three different groups: pharmacists, pharmacy technicians, and store managers. All of the programs cover the red flags identified by the DEA, and they also handle issues like security for controlled substances. The first of these Web-based tools was rolled out at the beginning of 2015, and each one can be customized for each company to incorporate its own procedures. “We want to make it very easy by providing a solution that is broad and still covers how to identify and resolve those red flags,” Bell says. The programs also serve as continuing education credits for pharmacists, which is a required component of their certification.

Creating these programs is only one part of educating the public, though. NACDS keeps in constant contact with its members to make sure they have the most current information about DEA compliance. “I don’t wait for our pharmacies to come to me,” he says. “I go to them.”

The programs Bell and his partners are creating will be available to nonmember pharmacies, as well. NACDS is a member-driven organization, but the emphasis of this initiative is education, and that education is available for anyone who wants to access it, Bell insists. “Keeping companies apprised of new regulation is a big part of my role,” Bell says. “It’s why I took the job.”