From the Desk of the ACCP President

March 08, 2019
Suzanne Amato Nesbit, Pharm.D., FCCP, BCPS, CPE

The Pharmacist’s Responsibility to Patients with Opioid Use Disorder and Medication-Assisted Treatment

Suzanne Amato Nesbit, Pharm.D., FCCP, BCPS, CPE

As the opioid epidemic continues to engulf the nation, newer strategies to mitigate the associated untoward effects must be explored. Recent efforts have focused on stopping the abuse of prescription opioids through instituting guidelines, limits, and drug monitoring programs. Such efforts will modestly decrease deaths from prescription opioids and the prevalence of opioid use disorder (OUD). However, they may not substantially affect the overall toll of the opioid crisis. With the rise in illicit fentanyl and heroin use, other strategies to mitigate this problem must also be developed and implemented. Using a mathematical model, a recent study projects the total number of opioid overdose deaths to increase by 147% by 2025.¹

Other approaches in addressing the opioid crisis include providing widespread screening for OUD, improving access to treatment with buprenorphine and methadone, and increasing OUD training for health care professionals. Combating the stigma associated with OUD also remains an imperative. The recent signing of the SUPPORT for Patients and Communities Act will facilitate the implementation of many such strategies.² Currently, only about 20% of Americans with OUD report having received treatment in the previous year.³ Moreover, although nurse practitioners and physician assistants should permanently be included in the roster of those who prescribe medication-assisted treatment (MAT), clinical pharmacists’ impact on the care of patients with OUD should not be overlooked. Given that patients with OUD are often receiving complex medication regimens for other chronic conditions, treating them as they navigate the health care system can be fraught with challenges. Pharmacists have both an opportunity and an obligation to participate in the care of these patients. Furthermore, given that 60% of rural counties have no authorized prescribers of MAT because of its prescribing restrictions,⁴ pharmacists, as the most accessible health care professional, can help fill this void.

Pharmacists should be trained in OUD screening and treatment, OUD motivational interviewing, and the destigmatization of communication associated with OUD. The SUPPORT Act focuses on caring for the most vulnerable populations with OUD: pregnant women, children, and Medicare recipients. These patients typically have complex medication regimens that require adherence, vigilance, and optimization.⁴ With these factors in mind, ACCP is collaborating with the American Society of Addiction Medicine to explore broadening the pharmacy profession’s response to the gap in OUD care. Through this collaboration, ACCP in turn recently joined the Coalition to Stop Opioid Overdose (CSOO), a multidisciplinary group bringing together leading mental health, substance use disorder, and health care professional organizations to exchange ideas and collaborate. CSOO was formed to elevate the national conversation around opioid overdose and to help enact meaningful and comprehensive policy change that supports OUD prevention, treatment, and recovery services (see www.stopopioidoverdose.org/2019/02/12/american-college-of-clinical-pharmacy-joins-the-fight-to-stop-opioid-overdose).

As ACCP continues to expand its efforts to support the inclusion of clinical pharmacists as necessary members of team-based care aimed at resolving the opioid epidemic, we want to learn more about your involvement in these endeavors. Please e-mail [email protected] about your practice, research, and education efforts, as we want to hear how our members are advancing health care by taking part in this work.

I look forward to updating you in future ACCP presidential columns and communications on these evolving efforts as well as on the other steps in which the College is engaged to combat this crisis.

References

1. Chen Q, Larochelle MR, Weaver DT, et al. Prevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open 2019;2:e187621.
2. Congress.gov. All Information (Except Text) for H.R.6 – SUPPORT for Patients and Communities Act. Available at https://www.congress.gov/bill/115th-congress/house-bill/6/all-info?r=l. Accessed March 7, 2019.
3. Saloner B, Karthikeyan S. Changes in substance abuse treatment use among individuals with opioid use disorders in the United States, 2004-2013. JAMA 2015;314:1515-7.
4. Davis CS. The SUPPORT for Patients and Communities Act – what will it mean for the opioid-overdose crisis? N Engl J Med 2019;380:3-5.