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ABSTRACT
Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.
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Notes on contributors
Nicholas E. Hagemeier
Nicholas E. Hagemeier, PharmD, PhD, is an Assistant Professor of Pharmacy Practice in the Gatton College of Pharmacy within East Tennessee State University's Academic Health Sciences Center. He also holds an Adjunct Faculty position in the ETSU College of Public Health. Dr. Hagemeier's research interests include prescription drug abuse and misuse, communication behaviors, and development of research infrastructure in community pharmacy practice settings.
Arsham Alamian
Arsham Alamian, PhD, MSc, MACE, is an Assistant Professor of Epidemiology at East Tennessee State University's College of Public Health. Dr. Alamian's research interests include clustering of risk factors and behaviors, prescription drug abuse and misuse, and theoretical modeling of behaviors.
Matthew M. Murawski
Matthew M. Murawski, RPh, PhD, is an Associate Professor of Pharmacy Administration in the College of Pharmacy at Purdue University. Dr. Murawski's research interests include evaluation of pharmaceutical therapy-related quality of life, detection and quantification of adverse drug events, pharmacists' practice characteristics, and the role of community pharmacists in prevention and treatment of substance use disorders.
Heather Flippin
Heather Flippin, PharmD candidate, is a 4th professional year pharmacy student at the East Tennessee State University Gatton College of Pharmacy. She will graduate in May 2016.
Elizabeth J. Hagy
Elizabeth J. Hagy, PharmD candidate, is a 4th professional year pharmacy student at the East Tennessee State University Gatton College of Pharmacy. She will graduate in May 2016.
Robert P. Pack
Robert P. Pack, PhD, MPH, is Professor of Community & Behavioral Health, Associate Dean for Academic Affairs and Director of the Tennessee Public Health Training Center (LIFEPATH) in the College of Public Health at the Academic Health Sciences Center of East Tennessee State University. His research interests are in the areas of prescription drug abuse, misuse prevention, and public health workforce development.