• Meldon Kahan, Lynn Wilson, Elizabeth Francis Wenghofer, Anita Srivastava, Anne Resnick, Eva Janecek, and Carolynn Sheehan.
• Addiction Medicine Services Clinic, St Joseph's Health Centre, Toronto, ON. kahanm@stjoe.on.ca
• Can Fam Physician. 2011 Nov 1;57(11):e448-54.

ObjectiveTo explore pharmacists' beliefs, practices, and experiences regarding opioid dispensing.DesignMailed survey.SettingThe province of Ontario.ParticipantsA total of 1011 pharmacists selected from the Ontario College of Pharmacists' registration list.Main Outcome MeasuresPharmacists' experiences with opioid-related adverse events (intoxication and aberrant drug-related behaviour) and their interactions with physicians.ResultsA total of 652 pharmacists returned the survey, for a response rate of 64%. Most (86%) reported that they were concerned about several or many of their patients who were taking opioids; 36% reported that at least 1 patient was intoxicated from opioids while visiting their pharmacies within the past year. Reasons for opioid intoxication included the patient taking more than prescribed (84%), the patient using alcohol or sedating drugs along with the opioid (69.9%), or the prescribed dose being too high (34%). Participants' most common concerns in the 3 months before the survey were patients coming in early for prescription refills, suspected double-doctoring, and requests for replacement doses for lost medication (reported frequently by 39%, 12%, and 16% of respondents, respectively). Pharmacists were concerned about physician practices, such as prescribing benzodiazepines along with opioids. Pharmacists reported difficulty in reaching physicians directly by telephone (43%), and indicated that physicians frequently did not return their calls promptly (28%). The strategies rated as most helpful for improving opioid dispensing were a provincial prescription database and opioid prescribing guidelines.ConclusionPharmacists commonly observe opioid intoxication and aberrant drug-related behaviour in their patients but have difficulty communicating their concerns to physicians. System-wide strategies are urgently needed to improve the safety of opioid prescribing and to enhance communication between physicians and pharmacists.

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