As the U.S. faces another year of the ongoing opioid epidemic, community pharmacists remain one of the most powerful teams working to end it. Pharmacists far outperform prescribers in spotting patients abusing opioids. A 2013 study found that pharmacists were able to identify a greater number of patients (41%) abusing opioid pain relievers compared to prescribers (17%). By identifying these red flags, providing valuable information, and dispensing naloxone, pharmacists are actively fighting on the front lines.
In the past year, communities, government agencies, and the healthcare industry have made efforts to better deal with the crisis, but there’s still considerable room for improvement. What are some of the barriers standing in the way of progress?
Studies on the pharmacists’ role in opioid safety have found a number of issues, including:
- A lack of standardized practices and guidelines on how to deal with various stages of Opioid Use Disorder (OUD).
- A lack of confidence among pharmacists stemming from insufficient training on matters such as opioid safety and pain and addiction management. A 2017 study of Kentucky pharmacists found a correlation between self-perceived confidence in understanding addiction and the pharmacist’s willingness to dispense naloxone.
- No financial reimbursement for time spent counseling patients.
Efforts are already being made to address some of these problems. States such as Ohio have passed legislation allowing pharmacists to bill insurance companies for the time they spend counseling patients. SB 265, passed on April 5, 2019, recognizes pharmacists as healthcare providers in the state and allows for reimbursements for services like vaccine administration and drug administration management.
At the store level, pharmacists are also executing on plans and efforts to substantially cut opioid misuse.
One way pharmacists help communities is by limiting patient exposure to opioids. Patient screenings, which rely on personal experience and skill, are often backed by prescription drug management program (PDMP) software. These electronic databases track controlled substance prescriptions within a state, providing information on red flags such as patients trying to obtain multiple prescriptions from different doctors or those on high dosages that put them at the risk of overdosing. Missouri is currently the only state without a prescription drug database and their use is not always mandatory across states.
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Pharmacists are also well-placed to improve pain management techniques by counseling patients about alternative options and educating them on the health risks associated with opioids. One alternative that has gained considerable ground in the past year is CBD. Last year, Ananda Health released a study suggesting that CBD may reduce or eliminate opioid use and improve quality of life. According to the study, 53% of participants who added Ananda CBD to their treatment regimen reduced their use of opioids to manage chronic pain in 8 weeks.
Patient counseling is one of the most important ways of promoting safe opioid use. Patients on prescription opioids and their families would benefit from knowing:
- How to spot signs of addiction in themselves or close ones
- How to identify the signs of an overdose and what to do in the event of one
- FDA guidelines for properly storing and disposing of leftover drugs
- Maximum dosages to look out for
To improve upon patient education around opioids, pharmacies must focus on providing access to proper training for pharmacists and pharmacy staff. This encourages effective communication with patients and positions the pharmacy as an important source of information. The need for increased education was emphasized by a recent study conducted by researchers at UC San Francisco. For the study, researchers contracted 900 pharmacies in California to ask about disposing unused medications. Only 19% were able to provide instructions on how to dispose of opioids in line with FDA guidelines. Additionally, only less than 10% had an active opioid take-back program. These programs, offered by many communities and pharmacies, provide a safe way for people to return their unused and unwanted medications instead of disposing of them at home.
Offering Addiction Assistance
Addressing addiction — or the possibility of addiction — with patients is a delicate conversation. As the most accessible providers, pharmacists are in a good position to offer a safe space for patients who may be dealing with addiction and provide access to resources that can help. This includes local substance abuse referral programs, crisis hotlines, or treatment resources.
One such resource is naloxone, which reverses the effects of an opioid overdose. A highly effective strategy involves dispensing naloxone not only to people directly at risk but also to third parties that have a high chance of encountering people that have overdosed. According to one study, opioid overdose deaths reduced by 14% in states with increased access to naloxone. Many states have provided this access by enabling pharmacists to dispense naloxone without a patient-specific prescription. In Ohio, the number of patients receiving naloxone grew from 183 to 3,847 after the state made this provision for pharmacists in 2015. In addition to providing naloxone, pharmacists also provide necessary counseling to patients and their family members on how to appropriately use it.
As communities continue to refine their approach to combating the opioid epidemic, pharmacists must continue to cement their role in the eyes of the public. Patients often misunderstand or underestimate the potential for their pharmacists to be involved in their healthcare beyond dispensing medication. Therefore, establishing trust with patients is a necessary precursor to effective treatment.