The opioid epidemic is an ongoing and grave public health issue in the United States. In fact, it’s one that has been unwaveringly prominent since before the 1990’s. According to NIDA, more than 2 million Americans struggle with addiction as a result of opioid over-prescription. This number makes up roughly 8.5% of the total 23.5 million who struggle with drugs and alcohol collectively. Additionally, the CDC has determined that opioid abuse accounts for approximately two-thirds of fatal drug overdoses. With this overdose epidemic progressing throughout the country at alarmingly high rates, many pharmaceutical companies are stepping up to challenge the crisis. Walmart Inc. is now one of the many to have joined that list. On Monday, May 7th, 2018, the company announced their new 7-day opioid prescription limit policy.
Walmart’s Latest Opioid Prescriptions Policy
“We are taking action in the fight against the nation’s opioid epidemic… We are proud to implement these policies and initiatives as we work to create solutions that address this critical issue facing the patients and communities we serve.”
—Marybeth Hays, Exec. Vice Pres. of Health & Wellness and Consumables, Walmart USA
Walmart has always shown initiative in its policies aimed at reversing the effects of the national opioid crisis. Still, this particular move may change the course of the crisis entirely. Effective immediately, the retail giant will begin enforcing week-long limits to their customers’ opioid prescriptions.
The new policy states that pharmacists can only provide a 7-day supply (or less) of opioid pain medication to those with a prescription. This includes a 50 morphine milligram equivalent maximum per day. The policy will come into full effect for all U.S. Walmart and Sam’s Club pharmacy locations within the next 60 days— totaling about 5,300 across the nation.
The Walmart Opioid Stewardship Initiative
The health and safety of our patients is a critical priority; that’s why we’re taking an active role in the fight against our nation’s opioid issue – one that has affected so many families and communities across America… We have a comprehensive program with policies, programs and tools aimed at helping to curb opioid abuse and misuse. We are committed to being part of the solution both in our pharmacies and in our communities.
—Walmart’s Corporate Website
While this prescription limit is undoubtedly a massive advancement in the fight against the opioid crisis, it is not the only noteworthy contribution that Walmart Inc. has made so far. In fact, this new policy is just one of several extensions to the company’s pre-existing Opioid Stewardship Initiative.
Walmart’s Opioid Stewardship Initiative utilizes several methods for battling the opioid crisis through both Walmart and Sam’s Club pharmacies. Some of the other programs and policies include:
Prescription Drug Education
The Walmart pharmacy believes that the most effective way to slow and eventually end the opioid crisis is through education. After all, many people who develop opioid addictions do so after unwittingly misusing their prescriptions to treat chronic pain. With this in mind, it’s clear that those who use prescription opioids for pain relief may be severely misinformed about the risks. Or, they could be uninformed entirely. This is why much of the public blames Big Pharma for the perpetuation of the opioid overdose epidemic. So, naturally, education and open communication between doctors, pharmacists, and consumers should be (and is) a vital part of the solution.
As part of their Opioid Stewardship Initiative, Walmart sponsors several youth-based curriculums to educate the public about the risks associated with prescription opioid use. One such example is EverFi’s Prescription for Life program. So far, the programs that Walmart sponsors have helped inform and empower the community at large— but especially kids.
According to both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute of Drug Abuse (NIDA), personal prescriptions are one of the primary sources of opioid abuse. In fact, more than 65% of the people who abuse prescription opioids are getting them from friends and family, not through a doctor or pharmacist. To combat this issue, Walmart introduced a new, safe method of destroying leftover opioids at home: DisposeRx.
DisposeRx is a powder that breaks down pill contents for safe disposal. When combined with water and the unused prescription, it creates a thick, adhesive gel. When it settles, the gel binds to the pill bottle and becomes difficult— if not impossible— to remove. Then, the pill bottle and its contents become safe to throw away at home. Furthermore, people who use DisposeRx also have the option to bring their destroyed prescription to a designated drop-off location. Since January, DisposeRx has provided a practically effortless way for patients to ensure that no one can abuse their unused medicines.
During the announcement regarding the 7-day prescription limit on Monday, Walmart representatives also confirmed that customers who fill any new Class II opioid prescription at one of their pharmacies will also receive free DisposeRx packets and opioid safety brochures. Patients with Class II opioid prescriptions set to automatic refill will also be offered free DisposeRx packets every six months. Additionally, free DisposeRx packs and counseling are now available on request at any Walmart or Sam’s Club pharmacy nationwide.
DisposeRx is not Walmart’s only line of defense against the opioid epidemic. The vast majority of Walmart and Sam’s Club pharmacists do and will continue to recommend naloxone to customers who, according to CDC guidelines, may be at risk of an overdose.
Naloxone is a sort of overdose antidote; it counters the effects of opioid overdose. Many first responders and law enforcement officers carry it on hand in the event of an emergency, and it is also available over the counter in some states. The Walmart and Sam’s Club pharmacies located in pro-naloxone states can dispense it to those in need upon request. However, the pharmacies that don’t have state law on their side are fighting to have naloxone behind their counters as well.
So far, Walmart’s new programs and policies regarding opioid prescription are set to become effective immediately. Still, some of their new plans won’t become effective for months. For example, by the end of August 2018, Walmart pharmacists will have access to and use of NarxCare, the controlled substance tracking tool that assists pharmacists with dispensing decisions.
In addition to these other pending measures, Walmart and Sam’s Club will require electronic prescriptions for controlled substances (like opioids) effective January 1, 2020. Electronic prescriptions, or e-prescriptions, have been proven to be a better and safer method of filling opioid medications. Unlike written notes, they cannot be forged or altered, and pharmacists can track them more efficiently to catch falsifications. In their announcement, Walmart asserted that the implementation of e-prescriptions would help them reduce over-prescription errors and stop prescription fraud.
CDC Guidelines Regarding Opioid Prescription Limits
Regarding Walmart’s newest policy, their 7-day prescription limit follows the CDC’s guidelines for opioid prescription use. The CDC advises clinicians to prescribe the “lowest effective dose” of opioids for pain management since opioid abuse largely stems from prescription use. The guidelines state:
“Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed…”
Now, some states already enforce legal prescription limits. In states where this limit is legally less than seven days, both Walmart and Sam’s Club will adjust their policy per their state’s law. For example, Florida has a statutory opioid prescription limit of 3-4 days. So, Walmart and Sam’s Club pharmacies located in Florida would prescribe 3- or 4-day supplies to patients instead of 7-day supplies.
Public and Professional Responses So Far
For years, the opioid epidemic has taken a massive toll on the nation’s health, sense of security, and even finances. State governments, Congress, and the Trump administration have been (and still are) looking for effective ways to combat the opioid epidemic. Walmart’s new 7-day prescription limit has the potential to be a groundbreaking achievement, and so far it and similar policies have garnered a lot of support from the public and healthcare professionals alike. Still, not everyone is on board with the idea of limiting medication for conditions like chronic pain.
Some medical professionals are concerned that such strict regulations on medicine will negatively impact patient treatment. Many people in the public health community also believe that restricting doses or even access to pain medication would only cause more harm than good for people who suffer from chronic illnesses.
“We clearly need supply-side clampdowns to rein in an out-of-control pharmaceutical industry and to repair medical and pharmacy institutions warped by their influence. However, blunt, broad, one-size-fits-all versions of these policies could be incredibly damaging in a variety of ways…”
—Stefan Kertesz, a clinical addiction researcher at the University of Alabama
The American Medical Association (AMA), an influential group of physicians, has argued that prescription limits are unreasonable. Much of the AMA insists that such restrictions could hurt a physician’s ability to provide individualized care for patients. In an interview with The Hill, chairwoman of the AMA’s opioid taskforce Dr. Patrice Harris stated that:
“Pain is a complex, biopsychosocial phenomenon, and individuals experience pain in different ways. The AMA believes that decisions around dosages need to be left between the patient and the physician.”
In contrast, those in favor of the prescription limits argue that such measures are essential to:
- Lowering any given patient’s potential for addiction
- Reducing the rate of opioid over-prescription
- Suspending illicit use of opioid prescriptions
More than half of the country seems to agree. According to the National Conference of State Legislatures, 28 states have already begun enforcing some form of opioid prescription regulation, including limits, as of April 2018.
Now We Wait
Over-prescription and patient fraud are both leading factors in the perpetuation of the opioid crisis. With this in mind, it’s highly likely that limiting access to opioid prescriptions will, in fact, slow the epidemic. If their policy is successful, it could set a precedent for other pharmacies. At this point, only time will tell.
Opioid Addiction Help and Information at TTC
Companies like Walmart have made their dedication to addiction prevention and patient safety clear. Many of them are taking on preventative roles in battling the opioid crisis. In the meantime, those who have already developed an addiction to opioid prescriptions need help, too. At The Treatment Center of the Palm Beaches, our staff of seasoned medical professionals and counselors is here to help patients reclaim happy, healthy, and sober lives. If you or someone you care about is struggling with an addiction to prescription medication, please call us at (855) 889-5065. All calls are confidential.