Opioid Addiction and Overdose: New Legislation and How Pharmacists Play a Critical Role in the Epidemic

It is estimated that 46 individuals die of prescription opioid overdoses every day in the United States. The Centers for Disease Control and Prevention reported that more than 16,000 individuals in the United States died of opioid overdoses in 2013.¹ Results from the National Survey on Drug Use and Health demonstrate that almost 2 million Americans, 12 years or older, misused or abused opioid pain relievers in 2013.² The rise in overdose deaths resulting from the misuse and abuse of prescription drugs has been linked to overprescribing, a 300% increase in prescription opioid sales since 1999, and improper medication disposal.^3,4

On March 10, 2016, the United States Senate passed a bill to combat the growing heroin and opioid epidemic throughout the nation. The Comprehensive Addiction and Recovery Act, a bipartisan bill, was passed with a vote of 94 to 1, demonstrating overwhelming support to reduce opioid addiction and related deaths. This bill will provide $725 million of federal grant money to local and state governments, and nonprofit organizations, to expand program resources, education, and monitoring programs. In addition, funds could be used to develop drug treatment programs.

“Today, Americans suffering with opioid addiction are closer than ever before to getting the help they need,” said Senator Richard Burr (R-NC). “There are thousands of North Carolina families currently grappling with this addiction, and I am encouraged that the Senate has produced bipartisan legislation that will help end the devastating crisis hurting families across the country. We can reverse this disturbing trend that has ravaged the United States over the past few decades.”

Pharmacists are equipped to play an important role in reducing opioid misuse and abuse, but are often an underused resource. Pharmacists have unique clinical knowledge, as well as an obligation to ensure that all efforts are made to prevent substance abuse in their communities by providing education, using prescription drug monitor programs, and providing patients and families with lifesaving resources.

Education Strategies

Education is a crucial first step in tackling prescription abuse. Parents and teenagers should be targeted for education due to the many misconceptions about drug use. Illegal drugs are commonly discussed, but many individuals fail to understand the risks associated with prescription drugs, especially opioids. Many parents are also unaware that teens are abusing prescription drugs and, therefore, are unsuccessful in safeguarding access to those medications in the home. In the 2009 National Survey on Drug Use and Health, 70% of individuals who reported nonmedical use of pain relievers obtained them from relatives or friends, whereas only 5% of individuals reported getting them from a drug dealer or via the Internet.⁵ Because opioids are commonly prescribed and are readily available in most homes, it is important to educate families on the potential abuse that can result from easy access.

Pharmacists can reach out to their communities by participating in public substance abuse education and prevention programs, collaborating with other health care providers (HCPs), and working with local, state, and federal authorities to combat controlled substance abuse. Educating patients on proper storage and disposal of excessive, unused, and expired medications should become routine practice for pharmacists. Directing patients to local drop boxes, or other safe ways to dispose of medications, can further help to prevent medication diversion and abuse.

Prescription Drug Monitoring

Statewide electronic databases, such as prescription drug monitoring programs (PDMPs), can be effective tools for pharmacists in identifying the appropriate use of controlled prescription medications. As of 2014, 49 US states have operational PDMPs in place to track the prescribing and dispensing of controlled prescription medications.⁶ This statewide electronic tool is used by prescribing physicians and pharmacists to provide data on prescribing and dispensing histories of controlled substance prescriptions, including opioid medications. Although this tool has proven to be useful in preventing drug diversion, it is only useful if HCPs use the system prior to prescribing and dispensing.⁷ Pharmacists must continue to regularly use their state PDMP and inform other HCPs of the importance of its use. With added federal funding, additional local and state governments may be encouraged to establish effective PDMPs to monitor prescription drug use in their states.⁸

Patient Resources and Assistance Programs

Pharmacists can play a role in patient assistance by identifying individuals who have a substance abuse problem and referring them for evaluation and treatment. Pharmacists are equipped to identify individuals at greater risk for overdose or addiction, as well as recommend and provide lifesaving antidotes to family members in case of an opioid overdose. Family members should be counseled to look for signs of an opioid overdose (Table 1⁹). The typical signs of an opioid overdose should be communicated to family members of an opioid user. With opioid antagonists, such as naloxone nasal spray and Evzio auto-injection, lives can be saved by simply administering the medication to reverse the effects of opioids. Available naloxone products are listed in Table 2¹⁰. Community-based overdose prevention programs, such as Project Lazarus, focus on increasing access to naloxone for prescription opioid users. Physicians are encouraged to prescribe the antidote to patients at high risk for opioid overdose. Through this program, patients taking opioids, and their family members, are educated on how to use naloxone and are provided with a naloxone kit for home use.

Summary

Through new laws and increased funding, HCPs can expect to see an increase in the use of drug monitoring programs, drug treatment programs, and education and resources for families of individuals using opioids. To help prevent misuse or abuse of these drugs, pharmacists must be diligent in ensuring that opioid medications are dispensed to individuals who legitimately need them. Although pharmacists may not be able to eliminate all opioid misuse and abuse, a number of resources and strategies can be used to improve patient care and public safety, including adequately educating patients and the public about the dangers of prescription medications, ensuring that patients are aware of proper medication disposal practices, diligently using operational statewide PDMPs, and providing families of opioid users with opioid overdose kits.

Acknowledgments

The authors thank Jordan Ballou, PharmD; Harkin Hayes Jr., PharmD; Laura Rhodes, PharmD; Chelsea Renfro, PharmD; and Alicia Watkins, PharmD, for their suggestions regarding the content of this article.

Desiree Gaines is a PGY1 community pharmacy resident with the University of North Carolina at Chapel Hill and Moose Pharmacy. Ashley Branham, PharmD, is the director of clinical services at Moose Pharmacy, in Concord, North Carolina.

References

• National Vital Statistics System mortality data. CDC website. cdc.gov/nchs/deaths.htm. Accessed April 4, 2016.
• Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.
• Chang HY, Daubresse M, Kruszewski SP, Alexander GC. Prevalence and treatment of pain in EDs in the United States, 2000 to 2010. Am J Emerg Med. 2014;32(5):421-431. doi: 10.1016/j.ajem.2014.01.015.
• Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010. Med Care. 2013;51(10):870-878. doi: 10.1097/MLR.0b013e3182a95d86.
• Results from the 2009 National Survey on Drug Use and Health (NSDUH): National Findings, SAMHSA (2010). Substance Abuse and Mental Health Services Administration website. oas.samhsa.gov/NSDUH/2k9NSDUH/2k9ResultsP.pdf. Accessed April 4, 2016.
• Status of state prescription drug monitoring programs (PDMPs). National Alliance for Model State Drug Laws website. namsdl.org/library/1E4808C8-1372-636C-DD0293F829471A7E/. Accessed March 13, 2016.
• Simeone R, Holland L. An evaluation of prescription drug monitoring programs. Simeone Associates, Inc, website. simeoneassociates.com/simeone3.pdf. Published September 1, 2006. Accessed April 4, 2016.
• Project Lazarus website. projectlazarus.org. Accessed March 13, 2016.
• Lank PM, Kusin S. Ethanol and opioid intoxication and withdrawal. In: Adams JG, ed. Emergency Medicine. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:154.
• Lexi-Drugs. Lexi-Comp, Inc, website. online.lexi.com. Accessed March 10, 2016.