Addressing Substance Abuse Requires Heightened Awareness

At the start of the opioid epidemic, public health officials used startling statistics to increase awareness. For example, they compared the large number of motor vehicle accident deaths with the even greater number of opioid overdose deaths. Officials also reported a decline in life expectancy among Americans between 2016 and 2017 that was directly linked to drug overdoses and suicides.¹

Years later, the number of annual opioid overdose deaths remains more than 5 times higher than it was in 1999, and Americans are still more likely to die from an overdose than a vehicle accident. In 2023, approximately 43,000 people died in motor vehicle accidents, whereas approximately 79,000 died from opioid overdoses.^2,3

Still? Yet? Again?

Many pharmacy professionals look at these statistics and sigh. So many interventions in recent years have been difficult to implement and caused stress in the pharmacy (Table 1^4-6), and opioid overdoses continue. It is exhausting, but it is important to realize that no quick fix will solve this problem. Experts indicated in 2017 that death rates were likely to continue to be too high and people’s lives would be adversely affected even if treatment availability increased markedly and immediately.⁴ That prediction has certainly been true.

Few Options, Many Barriers

Clinicians and public policy makers greeted the March 2023 FDA approval of OTC naloxone with hope. Naloxone reverses an opioid overdose by blocking opioid receptors, and although it is widely available, many people find its price (approximately $30-$50 for a 2-dose pack) unaffordable.^7,8 Its availability is often spotty in rural and low-income areas, stigma continues to be an issue, and some pharmacy employees refuse to recommend or stock it.^8-12 Furthermore, many people are nervous about using naloxone without training, emphasizing the need for public education campaigns.¹³ This is an area where pharmacists can provide counseling to increase the likelihood that people will use naloxone when needed—and correctly.

Although naloxone plays a critical role in reversing overdoses and saving lives, it does not address the underlying disorder. For individuals with opioid use disorder (OUD), longer-term strategies such as medication-assisted treatment (MAT) are essential. Data on access to MAT, including buprenorphine, buprenorphine/naltrexone, methadone, and naltrexone, are sparse, so it is unclear whether access has increased significantly. MAT combines FDA-approved medications with behavioral therapies in patients with OUD. It can manage some physical symptoms associated with OUD while helping patients cope with psychological and emotional issues. The 2008 Mental Health Parity and Addiction Equity Act requires group health insurance plans to provide identical benefits for substance use disorders and medical or surgical care, so most plans cover at least part of the cost.¹⁴

Watch the Streets

Sometimes, when patients lose access to prescription opioids, they turn to the streets for alternatives based on “recommendations” from social media and acquaintances. Pharmacy staff must know that some substances with opioid-like effects are available in smoke shops, gas stations, and online. They fall into a gray area in terms of the need for FDA approval. Table 2¹⁵ lists 3 such substances, with important points. Consumers may try to self-manage medical conditions or simply use them recreationally. Consumers need to know that these substances are closely associated with the risk of developing serious adverse effects or dependence.

Conclusion

Although progress toward fewer or no opioids deaths has been slow, incremental progress is being made. Pharmacists and pharmacy technicians need to keep an ear to the ground because many patients look for work-arounds when they can’t access prescription opioids, and many of those work-arounds are dangerous. Educating patients about those dangers can save lives.

REFERENCES

1. Opioid overdose tops list of leading causes of death in the US. American Society of Hematology. January 14, 2019. Accessed September 25, 2025. https://ashpublications.org/ashclinicalnews/news/4317/Opioid-Overdose-Tops-List-of-Leading-Causes-of

2. All injuries. CDC. Updated January 17, 2025. Accessed September 25, 2025. https://www.cdc.gov/nchs/fastats/injury.htm

3. Drug overdose deaths: facts and figures. National Institute on Drug Abuse. August 2024. Accessed September 25, 2025. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#Fig1

4. Phillips JK, Ford MA, Bonnie RJ, eds. Evidence on strategies for addressing the opioid epidemic. In: Phillips JK, Ford MA, Bonnie RJ, eds. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press (US); Washington DC. July 2017. Accessed September 25, 2025. https://www.ncbi.nlm.nih.gov/books/NBK458653/

5. Seeking solutions: confronting the opioid crisis. Wake Forest University School of Medicine. Accessed September 25, 2025. https://school.wakehealth. edu/features/research/opioid-crisis

6. Saunders H, Rudowitz R. Will availability of over-the-counter Narcan increase access? KFF. September 19, 2023. Accessed September 25, 2025. https://www.kff.org/medicaid/will-availability-of-over-the-counter-narcan-increaseaccess/

7. Madison B. How much does Narcan cost? GoodRx. January 29, 2024. Accessed September 25, 2025. https://www.goodrx.com/narcan/how-much-is-narcan-otc

8. Gravlee E, Wartman C, Rosenthal M. Over-the-counter naloxone availability:insights from rural community pharmacists in the southern United States. J Am Pharm Assoc (2003). 2025;65(3):102357. doi:10.1016/j.japh.2025.102357

9. Wright D. Increased availability of naloxone will help underserved communities, but price may increase and stigma may remain. Rutgers School of Public Health. May 3, 2023. Accessed September 25, 2025. https://sph.rutgers. edu/news/increased-availability-naloxone-will-help-underserved-communities-price-may-increase-and

10. McDonald R, Strang J. Are take-home naloxone programmes effective? systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016;111(7):1177-1187. doi:10.1111/add.13326

11. Morean ME, Kong G, Camenga DR, Cavallo DA, Simon P, Krishnan-Sarin S. Latent class analysis of current e-cigarette and other substance use in high school students. Drug Alcohol Depend. 2016;161:292-297. doi:10.1016/j. drugalcdep.2016.02.018

12. McLean K, Murphy J, Kruis N. “I think we’re getting better but we’re still not there”: provider-based stigma and perceived barriers to care for people who use opioids (PWUO). J Subst Use Addict Treat. 2024;159:209270. doi:10.1016/j.josat.2023.209270

13. Cooper-Ohm S, Habecker P, Humeniuk R, Bevins RA. Factors associated with gaps in naloxone knowledge: evidence from a 2022 great plains survey. Harm Reduct J. 2024;21(1):37. doi:10.1186/s12954-024-00954-7

14. Does insurance cover treatment for opioid addiction? US Department of Health and Human Services. Updated December 16, 2022. Accessed September 25, 2025. https://www.hhs.gov/opioids/treatment/insurance-coverage/ index.html

15. Law: “gas station” drugs: a regulatory void. University of Connecticut School of Pharmacy. Accessed September 25, 2025. https://pharmacy.uconn.edu/ course/gasstation/