THE JAPANESE COMMUNITY PHARMACIST AS A "GATEKEEPER" FOR PREVENTING PRESCRIPTION DRUG OVERDOSE

Introduction. Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. The Japanese government has expected community pharmacists to act as gatekeepers for prescription drug abusers. This study aimed to examine the pharmaceutical practices adopted by community pharmacists to prevent prescription drug abuse. Method. We surveyed all registered community pharmacies with dispensing functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about pharmaceutical practices such as referral to the prescriber if prescription drug overdose is expected. Result. Questionnaires were completed by 1416 pharmacists (response rate of 76%). Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. On multivariable analysis, a poor self-evaluation of referral to the prescriber was significantly associated with the following perceptions by pharmacists: “Insufficient confidence in communication with prescribers” (OR = 2.7, 95% CI = 1.4–5.3), and “To avoid trouble with prescribers” (OR = 1.7, 95% CI = 1.0-2.7). Conclusion. All prescribers should understand the importance of referrals by community pharmacists, in order to assist the community pharmacists to play the critical role of gatekeeper for preventing prescription drug overdose.