Practice Title: Locking Pill Bottles Increases MOUD Safety and Access
Department: Union County Health Department
Size: Medium (Population of 50,000-499,999 people)
State: Ohio
Summary of Practice:
The Union County Health Department (UCHD) is a government agency that serves approximately 62,784 county residents through its four divisions: Health Promotion & Planning, Environmental Health, Nursing, and Administration (including Vital Statistics). Union County is a primarily rural area, northwest of Columbus, Ohio. According to the 2021 US Census, Population Estimates Program, Union County’s population is composed of individuals that are reported as White (90%), high school graduates (94%), and between the ages of 18 and 64 years (56%). The median age of a Union County resident is 38.2 years with the median household income being $88,565.
According to the Ohio Department of Health, in 2007 unintentional drug poisoning became and continues to be the leading cause of injury death in Ohio. In 2017, the United States, including Union County, experienced a sudden sharp increase in fatalities as a result of overdose as the introduction of a new drug ‘Fentanyl’ was introduced to the drug supply. In response to this increase, Union County formed the Union County Overdose Prevention and Fatality Review Coalition, now called the Union County Drug Overdose Prevention Coalition (DOPC). Established in 2018, the DOPC focuses on implementing evidence-based strategies and surveillance measures to monitor and respond to drug overdose trends.
In 2020, Ohio experienced the highest number of documented overdoses in a year. During this time, many communities, including Union County, searched for strategies to help curb the sharp increase in overdose deaths. One strategy the DOPC implemented was the use of SafeRx locking pill bottles, specifically for medication-assisted treatment (MAT) patients who had opioid-use disorder (OUD). The primary goal of the Union County Locking Pill Bottle Pilot Project was to increase access to medication for opioid-use disorder (MOUD) by decreasing barriers including stigma and medication safety.
It is important to know that MOUD is a frequently used treatment strategy where clients take controlled medication to mediate their drug-seeking cravings. MOUD works best when paired with cognitive behavioral therapy as well as addressing past trauma. MOUD often involves an individual taking medication repeatedly throughout the day with adherence to a specific time dosing schedule. The Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMSHA) recommend using a locked box and/or locking pill bottle caps to ensure this medication is safely stored. The SafeRx locking pill bottle meets these recommendations as it offers a portable and secure option as well as allows patients to safely use MOUD. The security of this bottle has been shown to ease the minds of individuals who would benefit from MOUD, yet have concerns about the safety of the medication to prevent diversion. Tragically, Union County has experienced incidents where parents have inadvertently given their MOUD to their child resulting in a youth overdose/poisoning. In these instances, the SafeRx bottle could have prevented misuse overdoses as the bottle is a different color and requires a code to open and obtain the medication.
Using these national recommendations, the DOPC piloted a project prioritizing individual with OUD who were considering or are already enrolled in MOUD and receiving medication in Union County. The health department-led coalition partnered with Lower Lights Christian Health Center (LLCHC), the county’s Federally Qualified Health Center (FQHC), and locally-owned pharmacies to implement the SafeRx bottles with their clients. This partnership experienced initial success, and recommendations were made to replicate the process with other pharmacies.
The DOPC worked with additional pharmacies and providers across the county to provide education on MOUD. This education focused on increasing awareness of best practices regarding medication storage and decreasing the stigma surrounding the use of this treatment tool and OUD. Through this education, prescribers in Union County were made aware of specific pharmacies that were using SafeRx bottles and encouraged to include the SafeRx bottle when prescribing MOUD. When it was identified that a MOUD patient was going to be receiving a bottle from a participating pharmacy, the prescribers were tasked with writing SafeRx in the prescription. Pharmacies were then required to provide the SafeRx bottle with the MOUD medication and include medication safety information. This ensured that patients were receiving education on the benefits of SafeRx from both their prescriber and the pharmacy.
To successfully roll out the project, DOPC worked with first responder agencies including the Ohio State Patrol and the Union County Sheriff’s Office. DOPC presented information to these first responder agencies about MOUD, the pilot project, and how to identify the bottles during a crisis intervention training class. The purpose of this training was to ensure that first responders would be able to recognize a SafeRx bottle, feel prepared if they were to encounter one in the field, as well as decrease the stigma surrounding the use of MOUD. Often there is a negative stigma associated with MAT and MOUD. Since individuals use controlled substances to curb their cravings, some individuals do not consider MOUD patients as “sober” and, therefore, consider these individuals in active use. This stigma contributes to barriers individuals can face when trying to receive access to this treatment.
LLCHC in Franklin County implemented the locking pill bottles first in 2021 and surveyed participating patients. In November 2022, the DOPC created a survey based on the 2021 LLCHC project and distributed them to the pilot project patients. Before the implementation of the locking pill bottles, 11% of the patients reported they had misidentified their medication, and 39% reported they had noticed medication missing from their regular bottles. After implementation, 100% of the patients reported they had not observed missing medication or misidentifying their medication. Based on the survey results, the bottles have demonstrated that they are serving the intended purpose of making patients feel safer and more comfortable participating in the life-saving treatment of MOUD.
These efforts together helped make MOUD in Union County more accessible, thus decreasing the chances for individuals to return to illicit substance use and potentially experience an overdose.
The UCHD website can be found at: www.uchd.net.
Locking Pill Bottles Increases MOUD Safety and Access
Category
Injury and Violence Prevention
Description