More Than Half of Pharmacies Fail to Inform Customers of Dangerous Drug Combinations

Out of 255 pharmacies, fifty-two percent sold dangerous drug pairs without mentioning potential interaction

More Than Half of Pharmacies Fail to Inform Customers of Dangerous Drug Combinations
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December 22, 2016

An alarming number of pharmacies fails to inform consumers about potentially dangerous drug interactions when they fill their prescriptions.

"Millions of consumers at risk"

The Chicago Tribune (CT) recently conducted a study in which reporters visited 255 pharmacies with prescriptions for medications that, when taken together, can have dangerous—even fatal—effects. The result?

"Fifty-two percent of the pharmacies sold the medications without mentioning the potential interactions," reported the paper, calling the result "striking evidence of an industrywide failure that places millions of consumers at risk."

CT reporters went to large chains as well as to independent pharmacies. CVS—which is the biggest pharmacy retailer in the country when calculating by the number of stores—filled the prescriptions with no mention of an interaction 63 percent of the time. At 30 percent, competitor Walgreens experienced the lowest failure rate out of all the pharmacies tested; however, this figure means that the pharmacy still missed almost one in three interactions.

Several pharmacies committed to make significant reforms to improve patient safety in response to CT's investigation, including CVS, Walgreens, and Wal-Mart. Taken together, the steps they will take to achieve this goal will affect 22,000 drugstores and make 123,000 pharmacists and technicians across the country undergo more training.

Tom Davis is the vice president of pharmacy professional services at CVS. "There is a very high sense of urgency to pursue this issue and get to the root cause," he said.

The pharmacy—which dispensed drugs for roughly one billion prescriptions in 2015—said that it would improve policies as well as its computer system in order to "dramatically" increase warnings given to patients.

Among the changes committed to by Walgreens was increasing pharmacist training.

"We take this very seriously," said Walgreens Vice President of Pharmacy and Retail Operations and Planning Rex Swords.

The Last Line of Defense

Dangerous combinations of drugs are a major hazard to public health. Every year, tens of thousands of people are hospitalized due to interactions between the medicines they take. Pharmacists are considered the last line of defense against such occurrences, a role that continues to grow as Americans use more prescription drugs than ever before. One out of every 10 people takes five or more drugs—twice as many as in 1994.

Not all pharmacists dropped the ball, fortunately.

"You'll be on the floor," said one Walgreens pharmacist on Chicago's Northwest Side. "You can't have the two together."

"I've seen people go to the hospital on this combination [of drugs]," noted a pharmacist at a Kmart in Rockford, IL.

Others, however, filled prescriptions at what CT described as a "fast food pace, with little attention paid to customers." There were combinations of medicines that could trigger a stroke, lead to kidney failure, remove oxygen from the body, or result in an unexpected pregnancy with a risk of birth defects, and many pharmacists missed the dangers.

The location of the pharmacy made no difference in this cases. Pharmacists didn't spot the dangers in poor South Side neighborhoods, affluent suburbs, and the Gold Coast, a wealthy historic district. Even the Walgreens at downtown Chicago's Northwestern Memorial Hospital failed the test.

CT also visited independent pharmacies, which often claim to provide more personalized care than larger retailers. Surprisingly, when taken as a group these pharmacies experienced a higher failure rate overall than any of the chains: 72 percent at independent pharmacies compared with 49 percent at the chains.

Assembly Lines

Fundamental flaws within the pharmaceutical industry have been exposed by the study. Safety laws are being broken, computer alert systems meant to flag dangerous interactions between drugs either don't work or are ignored, and fast service is sometimes valued over patient safety. When interviewed, several pharmacists working at chain retailers described conditions resembling an assembly line, staff members scrambling to fill hundreds of prescriptions every day.

Wal-Mart, which owns 4,500 pharmacies in the U.S. , failed 43 percent of its tests. It said that it will update and improve its pharmacy alert system and will train pharmacists regarding the changes.

Kmart failed 60 percent, a result that was disappointing to Phil Keough, pharmacy president for Sears Holdings, which owns Kmart.

"While not happy, we also take this as an opportunity to look in the mirror and see where we can get better," he said.

Costco—a membership warehouse club whose pharmacies are open to everyone—also failed 60 percent, but did not comment.

CT also visited Jewel-Osco and Mariano's, two chains local to the Chicago area. Jewel-Osco failed 43 percent of the time, and Mariano's failed 37 percent.

In a statement, Jewel-Osco assured the newspaper of its focus on the well-being of its patients: "Osco pharmacists have a history of providing knowledgeable, exemplary care to our customers and their health, well-being and safety is our primary concern."

Mariano's responded in similar fashion, explaining the factors involved in filling patient prescriptions. "None of our pharmacists are intentionally disregarding drug interactions or patient safety," it wrote. "Our pharmacists look at each patient profile which includes patient history, allergy profile, pre-existing conditions and other factors such as age, all of which must be considered when assessing the potential for a drug interaction."

However, pharmacists working at Marino's locations rarely requested all of that information from the reporters.

A Unique Position

As the people who actually write the prescriptions, doctors carry great responsibility in protecting people from dangerous drug interactions. However, they do not always communicate, so one may not know which medicine another has prescribed. And research shows that doctors often know little about specific interactions.

Pharmacists, as the ones who fill the prescriptions, have a unique position. They are in a place to be able to detect potential interactions, warn patients about them, and prevent harm. They consider it to be one of their primary duties, in fact. However, until now there has been little data about how well pharmacists carry this theoretical duty over into practice in the real world. So CT decided to find out.

The paper brought in two experts on drug interactions to choose the pairs of drugs that reporters would have prescriptions for: pharmacy professors Daniel Malone from the University of Arizona and John Horn from the University of Washington. They chose five pairs of medicines, including three pairs that could be fatal. Another pair could cause a patient to faint. The fifth included an oral form of birth control and could lead to an unplanned pregnancy.

Each of the drugs, said the professors, had already been available for years, so the pharmacists should know about the interactions and catch them easily. Horn described them as "no-brainers."

The paper then recruited Chicago physician Dr. Steven C. Fox to write the prescriptions. Many of Fox's patients are elderly and rely on multiple medications in real life, so he had firsthand experience with the risks of drug interactions.

Fox wrote the prescriptions in the names of 18 reporters from CT, and 15 of those reporters then went out to pharmacies to have them filled. They tested 30 stores at seven major chains in addition to several independent pharmacies. Although most of the stores were in the Chicago area, some were in Indiana, Wisconsin, and Michigan.

Fifty-two percent failed the test.

Part 2