Pharmacists are Essential in Curbing the Opioid Crisis in Older People

Overdose deaths involving prescription opioids increased nearly 5-fold from 1999 to 2020, with more than 263,000 lives lost to prescription opioid overdoses since 1999.¹ Additionally, recent studies have demonstrated that people over 65 years of age were more likely to die of opioid use disorder (OUD)-related complications, and are more likely to experience a drug interaction that magnifies the risk of an opioid-related mishap.²

The opioid crisis has continued to escalate in the setting of the COVID-19 pandemic. As the risk of respiratory depression is elevated with opioid use, the risk of complications from COVID-19 is increased in patients with OUD. A feature published in the February 2023 issue of The Senior Care Pharmacist emphasized the importance of pharmacists in helping combat the opioid crisis, particularly in older people.

For many years, pharmacists have been recognized as one of the most accessible health care providers. Thus, pharmacy-supported initiatives have begun to garner attention as effective approaches to improve access and quality of care. This review summarized several successful team-based approaches involving pharmacists and physicians in managing OUD.

A recent workshop on methadone treatment for OUD sponsored by the Office of National Drug Control Policy in the Executive Office of the President incorporated pharmacists into a collaborative care model.³ They concluded that pharmacy dispensing of methadone with coordinated, comprehensive care in an opioid treatment program increased satisfaction in stable patients treated for at least 6 months. Patients did not appear to return to opioid use, according to the investigators.

Another study enrolled 71 patients prescribed buprenorphine with pharmacists managing patient monitoring.⁴ Physicians maintained prescribing, however, pharmacists dispensed buprenorphine after checking the prescription drug monitoring program and completing reconciliation.

They also provided patient education and monitored for other health issues and safety events. The results boasted excellent adherence and retention, few positive drug tests, no safety incidents, and exceptional patient and physician/pharmacist satisfaction ratings.

Last, several studies conducted in Canada concluded that patient access is increased with improved flexibility when pharmacies are integrated into the management of OUD.⁵

The author conveyed several recommendations regarding pharmacists facilitating care for OUD. Ensuring that community pharmacies stock and dispense buprenorphine is of the utmost importance.

Maintaining adequate coverage and reimbursement for these medications is also critical. Equally important is increasing the number of pharmacies that develop collaborative agreements with opioid treatment centers, as these models have shown great success. Throughout the COVID-19 pandemic, pharmacists have been essential in improving access to care. As such, society should capitalize on their expertise and accessibility to augment care for OUD.

About the Author

Sabina Alikhanov Palmieri, PharmD, Clinical Pharmacy Specialist, Community Health Network of Connecticut.

References

1. Overview. Centers for Disease Control and Prevention. Accessed March 13, 2023.https://www.cdc.gov/drugoverdose/deaths/prescription/overview.html
2. Watanabe JH. The Critical Role of Pharmacists in Treating Older People in the Opioid Crisis. Sr Care Pharm. 2023;38(2):47-49. doi: 10.4140/TCP.n.2023.47. PMID: 36751937.
3. National Academies of Sciences, Engineering, and Medicine; Action Collaborative on Countering the US Opioid Epidemic; Health and Medicine Division; Board on Health Care Services; Board on Health Sciences Policy. Methadone Treatment for Opioid Use Disorder: Improving Access Through Regulatory and Legal Change: Proceedings of a Workshop. (Stroud C, Posey Norris SM, Bain L, eds.). National Academies Press (US); 2022. Accessed March 14, 2023. http://www.ncbi.nlm.nih.gov/books/NBK585214/
4. Wu LT, John WS, Ghitza UE, et al. Buprenorphine physician–pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network. Addiction. 2021;116(7):1805-1816. doi:10.1111/add.15353.
5. Anstice S, Strike CJ, Brands B. Supervised Methadone Consumption: Client Issues and Stigma. Subst Use Misuse. 2009;44(6):794-808. doi:10.1080/10826080802483936.