Jerry McKee, PharmD, MS, BCPP
Clinical Pharmacy Specialist-Psychiatry
BalladHealth-Woodbridge Psychiatric Hospital
Substance Use Disorder and the Opioid Epidemic: How Pharmacists Can Help
Despite much local, state, and national attention, opioid drug overdose deaths continue to increase in the U.S. According to the Centers for Disease Control & Prevention (CDC), deaths from drug overdose are up among both men and women, all races, and adults of nearly all ages. More than three of five overdose deaths involve an opioid, resulting in the U.S. losing more than 100 citizens daily to unintentional opioid overdose deaths1. Also noteworthy is a 30% increase in emergency department visits related to opioid overdoses in the period July 2016 – September 2017. Due to the excess morbidity and mortality associated with opioid use, the CDC has developed comprehensive opioid use guidelines in chronic pain management to provide healthcare providers a framework to begin to move towards safer opioid prescribing2. The primary methods to prevent opioid overdose deaths are to improve opioid prescribing, reduce exposure to opioids, prevent misuse, and treat opioid use disorder.
The CDC continues to work closely with other federal agencies to support the Department of Health and Human Services’ five-point strategy to fight the opioid overdose crisis by:
- Improving access to prevention, treatment, and recovery services, including the full range of medication-assisted treatment;
- Better targeting availability and distribution of overdose-reversing drugs;
- Strengthening surveillance activities through timely public health data and reporting;
- Supporting cutting-edge research on pain and addiction; and
- Advancing better practices for pain management2.
As one can determine from reviewing the CDC’s five-point platform, pharmacists are in a unique position to help shape an effective response to the opioid crisis. The following are some thoughts regarding working with patients who are dealing with mental illness and/or substance use disorder (SUD), and how pharmacists should take steps to be involved in mitigating the opioid crisis.
Caring for patients with SUD involves unique challenges. Patients with mental illness and SUD face many barriers to accessing optimal care, including lack of access, lack of accurate disease information, limited financial resources, inadequate transportation, and stigma. It is well known that people with mental illness and SUD are often treated differently than those without these disorders, even by health professionals. These biases can serve as barriers to patients receiving optimal care, can hinder them from realizing their potential, and can be detrimental to their sense of well-being. It is essential that everyone, including health professionals, acknowledge biases and make certain that any preconceived notions are balanced by evidence.
To more effectively interact with patients with mental illness and SUD, specific training in effective interaction with such populations may be helpful. Motivational interviewing is one effective methodology that can be useful for all patient interactions. Mental Health First Aid (MHFA) training is also a great place to start. MHFA is an 8-hour course that provides skills to help someone who is developing a mental health problem or experiencing a mental health crisis. The evidence behind the program demonstrates that it does build mental health literacy, helping the public identify, understand, and respond to signs of mental illness. MHFA efforts are coordinated by the National Council for Behavioral Health, Maryland Department of Health and Mental Hygiene, and Missouri Department of Mental Health to ensure the quality and standardization of the program nationwide, certify instructors to teach Mental Health First Aid in local communities, and support program growth. MHFA, while intended for all people, is particularly of benefit to persons who regularly interact with persons with mental illness and SUD and their families e.g., pharmacists).
Board-certified pharmacists are recognized as leaders in their respective specialties. As the current opioid crisis affects all specialties, all pharmacists, must recognize patients at risk for overdose due to disease, pharmacotherapy, or other risk factors, and take steps to modify risk factors. Further, active participation at the local (harm reduction coalitions, community action groups) and state level (state pharmacy association, opioid action task force, etc.) is also imperative. As the recognized clinical pharmacy experts, board-certified pharmacy specialists must take a leadership role in addressing this crisis.
The College of Psychiatric and Neurologic Pharmacists (CPNP), the professional association which provides board certification preparation and recertification continuing education for Board Certified Psychiatric Pharmacists, has developed opioid risk/naloxone use/harm reduction educational resources specifically for community pharmacists. These resources, however, can benefit other pharmacists and physicians as well. This guideline document (found here) is intended to educate community pharmacists on interventions to provide safe and appropriate access to opioids while protecting the public from the hazards of misuse and abuse. This publication is supported by the American Academy of Addiction Psychiatry under its prime grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). CPNP is in the early stages of development of a comprehensive toolkit for pharmacists to assist with the opioid crisis. The ongoing support of BPS to encourage board-certified pharmacist specialists, the leaders of clinical pharmacy, to act (i.e. be part of the solution locally and nationally) in mitigating the opioid crisis is imperative.
My advice for student pharmacists, pharmacy residents, and practicing pharmacists interested in caring for patients with SUD, is that it’s important to take initiative and access the tools outlined above, as well as locating others available in your area. Contact local substance abuse and harm reduction coalitions to find out how you can become engaged with their efforts. Having the background, training, and skills to be confident and comfortable in caring for these patients goes a long way and assists these patients with their journey into recovery.
1 MMWR. March 29, 2018. https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html
2 CDC website.
Jerry McKee