COVID-19 and Substance Use Compound Challenges

As the coronavirus disease 2019 (COVID-19) pandemic continues, pharmacists and other health care professionals have had to contend simultaneously with the continuing substance use epidemic.

In a Pharmacy Times^® webinar titled “The Impact on Substance Misuse During the COVID-19 Pandemic,” participants discussed specific challenges for pharmacists and best practices for tackling the 2 problems.

Alcohol sales have increased, and data have shown the growing use of nonprescribed fentanyl, methamphetamine, and cocaine across the country, according to moderator Tyler Davis, PharmD, a senior advisor of pharmacy professional practice standards at CVS Health.

Jeffrey Bratberg, PharmD, FAPhA, agreed that this is a major issue, adding that there were more than 72,000 opioid over- dose—related deaths in 2019, many of which were related to polysubstance use.

“[Among] people who are surveyed during the pandemic who use drugs, we’ve seen a 13% increase in the number of people who have increased their use of substances,” said Bratberg, a clinical professor at the University of Rhode Island College of Pharmacy in Kingston. “While we can’t really correlate or put [the] causation of COVID-19 and opioid use or opioid deaths, [they’re] definitely correlated.”

Pharmacies offer a major opportunity to intervene with these patients because of pharmacists’ accessibility and the long hours that many pharmacies are open.

During the pandemic, pharmacies have been deemed essential businesses, whereas methadone maintenance programs and phy- sician offices have been either closed or operating with drastically limited hours, Bratberg said.

Pharmacists should work to meet the unmet needs of this population by offering harm-reduction strategies, naloxone, and other services, he said.

“One study from the CDC showed 3 out of every 5 people who died of an opioid-related overdose had a touchpoint with some part of the health care system, and I think pharmacy made up a great proportion of those touchpoints,” Bratberg said.

Pharmacy teams play a major role in preventing drug diversion and misuse, because many patients still need continued access to opioids for chronic pain and other controlled substances, according to Amanda Glover, PharmD, vice president of regulatory affairs at Rite Aid in Camp Hill, Pennsylvania.

Although the Code of Federal Regulations places the respon- sibility of proper prescribing and dispensing on the prescriber, a corresponding responsibility rests with the pharmacist, she said.

“Pharmacists are trained to look for certain red flags, such as patients filling prescriptions at multiple pharmacies from multiple pre- scribers, as well as pain [medication] and refill trends,” Glover said.

Ensuring that patients with opioid prescriptions have access to naloxone is a major goal that pharmacists can fulfill amid the opioid epidemic, although she noted that there is a general lack of awareness among the public about this option.

However, pharmacists can continue to promote awareness by keeping naloxone constantly in stock and working to destigmatize its use in accidental overdoses, as well as through pharmacy signage.

Research is underway to determine how substance misuse is related to the COVID-19 pandemic.

Bratberg described this research as being like “paddling down a very, very fast stream and ... you don’t know where it’s going.”

Fortunately, many states have reliable data on opioid overdoses, which is how investigators know there is an increase across many parts of the country. Despite these findings, Bratberg said that there are some encouraging signs.

In addition to the widespread adoption of telehealth that has increased patients’ access to counseling, the Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration have both made regulatory changes to increase access to evidence-based and mortality-reducing drugs, such as buprenorphine and naloxone.

“They’ve allowed states lots of leeway to continue to do what we do as pharmacists in the methadone perspective and what we do from the community pharmacy perspective with buprenorphine, and we can mail the drugs,” Bratberg said. “We can have curbside pickup,” he said. “We can have drive-through pickup, so that not only are pharmacists and their staff safe in the pharmacy but patients are kept safe.”

Although the effects of the COVID-19 pandemic have been alarming and wide-reaching, Bratberg said that there are many opportunities for pharmacies to take a leadership role in both the pandemic and the substance-abuse epidemic.

Pharmacists’ accessibility offers many opportunities to intervene with patients who may be at risk of substance misuse.

“We’re really recognized as public health nodes, right?” Bratberg said. “We’re accessible; we’re essential.”