File/Metro Creative - Some pharmacies across Iowa are stepping up in the fight against the opioid epidemic. A 72-hour policy for filling some controlled substances is part of the initiative.

Editor’s Note: This is part two of a two-part series reporting on opioid abuse. Part one, published Friday, featured the strict new rules issued by the Iowa Medical Board on prescribing the drugs.

In an effort to fight back against the national opioid crisis, two nationally-known companies operating in Central Iowa pharmacies have implemented new controlled substance prescription policies in the past year.

Hy-Vee Inc. operates in-store pharmacies in grocery stores as well as the Marshalltown Hy-Vee Drugstore. Walmart also operates a pharmacy in many of its stores.

The companies have developed a significant customer base and own a large part of market share.

Earlier this year, Hy-Vee announced the implementation of a new controlled substance prescription policy.

Specifically, it states as of Jan. 1, pharmacies will no longer allow a subsequent fill of a Schedule II controlled substance, or a refill of a Schedule III or Scheduled IV controlled substance more than 72 hours early without authorization from the prescriber.

“The opioid epidemic in the United States claims the lives of more than 100 people every day, and Hy-Vee is continually working to assist in the fight,” said Kristin Williams, senior vice president and chief health officer. “Implementing this 72-hour policy is one more step toward combatting the opioid epidemic in communities throughout the eight states we serve.”

The abuse potential for drugs is what determines how they are scheduled.

Schedule II substances, such as fentanyl and oxycontin have a high potential for abuse and may lead to severe psychological addiction, according to the U.S. Drug Enforcement Administration.

Meanwhile, drugs like Vicodin and Tylenol with Codeine are Schedule III substances that have moderate to low potential for abuse. Schedule IV substances, such as Valium and Xanax, are considered to have a low potential for abuse.

To treat opioid abusers in the short-term, Hy-Vee offers Naloxone in its pharmacies.

It can be administered to any person who has overdosed on a wide range of opioids, ranging from codeine to hydrocodone to morphine.

“Naloxone is available at Hy-Vee pharmacies in nasal spray and injection forms (upon request), although nasal spray is the most commonly used form,” according to Hy-Vee. “The drug is stored behind the counter and cost varies, depending on the form and whether a customer goes through his or her insurance or pays cash.”

Naloxone is not meant to be used long-term and has no effect if opioids are not present.

Hy-Vee and Walmart, like many other pharmacies nationwide, will require e-prescriptions for opioids effective Jan. 1, 2020.

E-prescriptions have proven to be less prone to errors, cannot be altered or copied and are electronically trackable.

In 2018, Walmart introduced new policies aimed at curbing opioid misuse and abuse in its U.S. and Puerto Rico pharmacies. Also included are Sam’s Club pharmacies.

As part of its fight against opioid abuse, Walmart offers a free opioid disposal solution, DisposeRx, in all pharmacies nationwide, according to a press release.

Additionally, Walmart and Sam’s Club restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50-milligram equivalent maximum per day.

This policy is consistent with the Centers for Disease Control and Prevention’s (CDC) guidelines for opioid use.

Walmart and Sam’s Club follow state laws that require filling new acute opioid prescriptions is less than seven days,

The company’s pharmacists counsel patients using the CDC’s guidelines on pain management, focusing on using the lowest effective dose for pain management for the shortest possible time period.

“We are taking action in the fight against the nation’s opioid epidemic,” Marybeth Hayes, executive vice-president of Health & Wellness and Consumables Walmart U.S. “We are proud to implement these policies and initiatives as we work to create solutions that address this critical issue facing the patients and communities we serve.”