Pharmacists Play Critical Role in Monitoring Controlled Substances | APhA 2025
Emily Leppien, PharmD, BCPS, BCPP, clinical associate professor of pharmacy practice at Binghamton University, discusses identifying potential red flags for substance use disorder.
Pharmacists play a critical role in monitoring and ensuring safe use of controlled substances, with a key focus on identifying potential red flags while maintaining patient-centered care, according to Emily Leppien, PharmD, BCPS, BCPP, clinical associate professor of pharmacy practice at Binghamton University. She outlined several important indicators that pharmacists should watch for, including patients paying cash, traveling long distances to fill prescriptions, using multiple prescribers, or being prescribed multiple controlled substances. These red flags are not automatic indicators of misuse but rather signals that warrant further investigation and understanding.
The PDMP (Prescription Drug Monitoring Program) emerges as a crucial tool for pharmacists, providing comprehensive insights into a patient's prescription history, drug interactions, and pharmacy usage. Beyond technical monitoring, Leppien emphasized the importance of addressing stigma surrounding pain management and substance use disorders. Pharmacists are encouraged to combat implicit biases through education, active listening, and compassionate communication.
Medication safety remains the paramount concern. Pharmacists are advised to provide thorough medication education, explaining both short-term and long-term risks of controlled substances. This includes discussing potential adverse effects, proper usage, and the importance of preventive measures like naloxone distribution. The approach is not punitive but collaborative, focusing on understanding patient needs and ensuring safe medication management.
The key message is to "trust but "verify"—pharmacists should approach potential red flags with an open mind, seeking explanations, and maintaining transparent communication with both patients and health care providers. By asking thoughtful questions and gathering context, pharmacists can distinguish between genuine concerns and misunderstood circumstances, ultimately prioritizing patient safety and well-being.
"[Try] to keep lines of communication open with the patient, but [remember] that we're not drug police and not every red flag is a problem," Leppien said.
