The Role of Pharmacists in Identifying and Managing Psychiatric Medication Overdoses

In an interview with Pharmacy Times, Nena Bowman, PharmD, DABAT, Director of Vaccine Operations Tennessee Department of Health, Nashville, TN discussed her presentation at the 2024 American Association of Psychiatric (AAPP) Conference. Bowman focused on the importance of pharmacist expertise in managing psychiatric medication overdoses. Bowman outlined trends seen in intentional overdoses, including increased polypharmacy. Bowman highlighted resources for pharmacists to access when handling overdose situations, such as consulting poison control centers. Lastly, Bowman emphasized factors to consider carefully when deciding whether to reintroduce medications after an overdose were also addressed.

Pharmacy Times

Why is it crucial for pharmacists to understand the overdose risks and management of psychiatric medications?

Nena Bowman

I think a lot of times, pharmacists forget that— or people forget that it's not a matter of if but more a matter of when right? A lot of times, toxicology, and poisonings they happen when we least expect it, not just in a hospital setting. But it could be a loved one, it could be someone as the trusted community medication expert. People come to you and tell you things that happen or ask questions about what happened. I think it's really important for pharmacists to understand not only that toxicology and poisoning will happen at some point in your career, but also that there are resources available to help. Knowing where to go and where to find information absolutely makes you an expert in the field.

Pharmacy Times

What trends are seen in intentional overdoses involving psychiatric drugs, and why is this concerning?

Nena Bowman

I think the biggest trend that we see is actually polypharmacy. More and more, we're seeing patients that not only are prescribed more medications, but also are getting into or supplementing their medication regimens with supplements, or products that live in this gray zone of legality. Things like kratom, things that come from our cannabis products. So not just marijuana, or delta nine, but we see patients using Delta eight, we see patients using CBD and all of those things have a huge impact on your medications, how they work in your body. I think that it's really concerning, because we don't have a lot of information on how these supplements and things work, or how they interact. It makes treating patients that overdose or have adverse effects from these combinations, it makes them really complex to treat.

Pharmacy Times

What guidance exists for managing psychiatric medication overdoses, and how can pharmacists access it?

Pharmacy Times

How can pharmacists identify and manage overdoses of psychiatric medications effectively?

Nena Bowman

My favorite resource is your local poison center. A lot of people don't know that poison centers are staffed by pharmacists, physicians, and even nurses that have toxicology, ICU, emergency medicine training, and they work through America's poison centers. They manage all the data that poison centers collect. You can call 24/7 — you can call your state's poison center and there will be someone there to help you. They have clinical and medical toxicologist that can help supplement and help you work through not just managing a complex patient, but even managing antidote therapy — how to administer them, how to mix them, things like that.

Nena Bowman

I think that's a complex question. Usually, you identify overdoses, it's a lot of patient reporting. That means that a lot of times, in an overdose situation, you don't know exactly what has been involved or how much, which makes patients hard to treat and hard for pharmacists to find the information to help them.I think that it's a complex question, but with some of the resources like the poison center and online resources through America's poison centers, there's a lot of references available to help identify and manage them.

Pharmacy Times

What factors should pharmacists consider when deciding whether to reintroduce psychiatric medications after an overdose?

Nena Bowman

A lot of times, pharmacists are the ones who are going to answer those questions. Pharmacists are your medication experts, whether you're in the community or you're in the hospital. There's a lot of factors that play into when it's safe to restart, and how to restart. Whenever I'm recommending these things, what I look at, is an overdose or poisoning, it is absolutely the best time to refocus, reevaluate. Does the patient need all the medications that they're on? Why are they there to begin with? Do some of the drugs have narrow therapeutic windows? Because if they do, maybe they're not the best medications for that patient in the moment. So, I think whenever we're talking about restarting medications after an overdose, it's a really delicate process. It's really complex. It takes a lot of consideration when it comes to the patient's lifestyle, what we're treating, and how well they've done on the medication regimen they've been on. So, it's very case by case and it is very complex. But I think with the resources that are available, pharmacists are the ones that are going to be asked. Being able to look those things up and look for support, that's going to help you the most.