Opioid Abuse: What Should Pharmacists Do About It?

Opioid abuse has been garnering more attention as efforts to address opioid-related overdose deaths have captured national attention, even taking on the form of an executive order from President Donald Trump.

In a session at the ASHP 2017 Summer Meetings and Exhibition in Minneapolis this week, Timothy P. Stratton, PhD, who is a professor of pharmacy practice at the Department of Pharmacy Practice & Pharmaceutical Sciences at the University of Minnesota College of Pharmacy in Duluth, discussed the current opioid epidemic and what pharmacists can do if they find themselves in an ethical dilemma related to prescribing of opioids or other similar ethical issues.

Stratton noted that in Minnesota alone, opioid overdose deaths increased 560% from 1999 to 2015. In 2015, there were more opioid OD deaths among 20- to 30-year- olds than among older people in that state.

He noted that a “perfect storm” of circumstances helped bring about the current epidemic, including one pain management “thought leader’s” financial ties to several pharmaceutical companies who claimed “no dose of opioids is too high.” Another part of the storm he mentioned was the fact that “patient satisfaction” became a quality measure, which was in turn linked to CMS payment. This translated to some physicians prescribing opioids inappropriately in response to patient satisfaction surveys.²

“Today’s opioid abuse crisis is the result of a perfect storm of circumstances that has been brewing for decades,” Stratton said. “It was a combination of some bad apples, some questionable policies, and some unintended consequences of well-meaning policies.”

All of these circumstances combined to lead to the situation that exists today, where many people have become addicted to opioids and may seek out illegal ways to get opioids, including abusing prescriptions.

Pharmacists can play an integral role in mediating these situations, like identifying who may be abusing medications, and serving as an intermediary by getting them to a treatment program. Stratton offered some practice pearls to pharmacists who may be facing ethical dilemmas, like patients that could be abusing their medication, during this talk. Specifically, he noted:

• “Determine if an ethical dilemma exists
• Determine the facts related to the dilemma
• Identify the principles and values at play
• Identify your goal in resolving the dilemma
• Generate possible reasonable solutions
• Analyze pros and cons of alternatives
• Select one alternative
• Anticipate potential objections.”

In an interview with Pharmacy Times, Stratton also commented on the availability of naloxone for people who may be addicted, noting that he feels that the push to make naloxone more widely available is “ethically responsible,” in that it will and already has helped reduce the amount of harm that people with addiction face.

References

• Stratton T. The Opioid Abuse Epidemic: How We Got to Where We Are. Presented at: ASHP Summer Meetings and Exhibition. June 4-6, 2017. Minneapolis.
• Falkenberg K. Why Rating Your Doctor is Bad for Your Heath. Forbes. Jan 21, 2013. Accessed: June 4, 2017.