The opioid epidemic has many faces.
Some feel familiar to us: the nameless junkies nodding off in public parks and on inner city street corners, the forlorn addicts who achieved internet infamy for overdosing in a car while their toddler looked on helplessly from the back seat or maybe it is even the misguided, rebellious characters popularized on the silver screen in the 1996 cult classic Trainspotting.
But some faces are not so familiar. And while you would probably never think of your sweet elderly neighbor, the soccer mom you share carpool duty with or your over-achieving teenage nephew as opioid abusers, the reality is that the epidemic’s demographics are widening. Quickly and considerably.
Once primarily the burden of the socio-economically disadvantaged and downtrodden, heroin addiction is no longer relegated to the inner city: a 2012 study found that the majority of today’s addicts are actually young, white suburbanites—75% of whom blame prescription opioids like OxyContin as kickstarting their addiction.
So where does your community pharmacist fit into this maelstrom?
It’s a great question, but before we can explain how such an unlikely ally factors in to the nationwide fight against this epidemic, we must first have a more complete understanding of the problem.
Underlying causes of the opioid epidemic
Pain. It’s no secret: no one likes being in pain. And that sentiment is backed up by numbers: on an average day more than 650,000 opioid prescriptions are dispensed in the U.S. If that sounds like a lot, it is. But what is more eye-opening is the absence of any hard data that supports the idea that Americans are experiencing more pain today than in the past.
So, why such an uptick in prescriptions? Well, for starters, in recent years pharmaceutical companies have ramped up their efforts to develop and launch aggressive marketing strategies for their products. And this push by Big Pharma has coincided with a considerable cultural shift in the patient population. Not only has prescription drug use become increasingly socially acceptable, we also live in a country where instant gratification is no longer just appreciated, it is expected. Add these factors up, and one can begin to understand why the number of opioid prescriptions has increased so dramatically.
The goodies in Grandma’s medicine cabinet
Of course, not all opioid related deaths are pegged to deliberate drug abusers; many are accidental overdoses.
For example, as elderly patients battle the onslaught of age and chronic conditions, they are likely to end up on prescription drugs. If an opioid prescription is paired with conflicting medications following a surgery, it can have fatal consequences. In fact, age alone can be a sufficient risk factor in some cases.
Unfortunately, and in spite their best intentions, the elderly cannot be completely absolved from the blame game. With war chests full of prescription drugs, they actually make the perfect target and are all too often turned into unwitting suppliers for family members and caregivers looking to pilfer their stockpiles of leftover prescription drugs for recreational use.
How community pharmacies can help
There are several ways community pharmacies can help fight the opioid epidemic.
First, pharmacies must report each controlled substance prescription dispensed to their state’s Prescription Drug Monitoring Programs (PDMPs). In turn, PDMPs must create a profile for each patient, which becomes a valuable catalogue that pharmacists can use to identify potential opioid abuse or diversion.
The effect PDMP enforcement laws have on lowering opioid-induced fatalities cannot be debated. A recent CDC study found that strengthening PDMP reporting standards led to a 50 percent decrease in Oxycodone overdose deaths. And in states like New York and Tennessee, the number of patients who visit multiple prescribers decreased by 75 and 36 percent respectively.
A second and equally important tool is the pharmacists themselves. Since PDMPs track when and how often patients pick up controlled prescriptions, pharmacists are in a prime position to recognize problematic patterns in drug use and proactively identify high-risk patients. Vigilant monitoring also allows pharmacists to recognize—and report—false or fraudulent prescriptions written by doctors willing to abuse their prescriptive authority for a sum.
But the role of community pharmacists can easily extend beyond problem recognition to care dispensing: once a potential abuser is identified, there are a few courses of care-based action that are immediately available to community pharmacists. First, Medication-Assisted Treatment (MAT)—and specifically opioid treatment programs (OTPs)—can be directly recommended to the patient. By combining medications, counseling and behavioral therapy, MAT is not only a FDA-approved treatment of opioid use disorders (OUDs), but research suggests that it is more effective than short-term detoxification programs focused on abstinence. In fact, reports show that patients who receive MAT/OTP services are able to reduce their risk of death from all opioid-related causes by half.
Pharmacists in 16 states also have the ability to prescribe and dispense Naloxone, a medication that, much like Narcan, is designed to rapidly reverse opioid overdose. While this measure is more focused on preventing opioid-related deaths than addressing the addiction itself, it has nonetheless proven very successful—so much so that it has inspired the funding of various CDC programs focused on pushing for more states to allow pharmacists to prescribe Naloxone to at-risk patients.
Lastly, community pharmacies are an invaluable resource for families of those struggling with opioid addiction. Not only are pharmacists an important educational resource, able to answer any questions regarding opioid addiction, but they can also direct families to the above-listed resources so they can receive a better understanding of their options and become part of the problem-solving process instead of being a bystander, or, even worse, enabler.
What should you do?
Today, more Americans die from drug overdose than car crashes. According to the CDC, 44 people die each day from prescription painkiller overdose. And the trend is not improving, with the number of heroin-related overdoses quadrupling between 2002 and 2013. That’s the bad news. The good news: we are in a position to reverse this trend... should we so choose.
How? Well, in this instance, the adage that knowledge is power has never rung more true. It is vitally important to stay educated about the risks and benefits of opioid use.
Any time an opioid is prescribed to you, it cannot be overstated how important it is that you have a discussion with your doctor about how much you should take and for how long. Once your pain has been managed, do not keep leftover pills lying around—safe storage and proper disposal of opioids will prevent them from falling into the wrong hands.
Learning to recognize the signs and symptoms of abuse in friends and loved ones today will pay dividends tomorrow. Also, while educating yourself on opioid abuse is of great importance, being willing and able to ask the difficult questions is equally crucial. If a loved one develops an opioid addiction, make sure they know their treatment options. Also, if you do find yourself in this situation, be proactive and make sure you have access to Naloxone and that you know how to use it—this will increase the amount of first responders available in emergency overdose situations.
More information regarding help for substance abuse problems can be found at the Substance Abuse and Mental Health Services Administration’s National Helpline: 1-800-662-HELP (4357).
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