Psychiatric Pharmacists Take a Larger Role in Substance Use Disorder Care

Psychiatric pharmacists have become more integrated into substance use disorder care (SUD), moving beyond naloxone dispensing to actively managing medications and treatment strategies. In an interview with Pharmacy Times, Ashley Maister, PharmD, BCCP, clinical pharmacy practitioner in mental health at the US Department of Veterans Affairs, and Aaron Salwan, PharmD, MPH, BCCP, clinical pharmacy specialist in behavioral health at Montefiore Nyack, discussed how pharmacists now initiate and adjust therapies for opioid and alcohol use disorders, including the use of long-acting injectable medications. They shared how psychiatric pharmacy training exposes pharmacists early to patients with co-occurring substance use and mental health conditions, fostering empathy and reducing stigma. Maister and Salwan also highlighted how this integrated approach allows pharmacists to better address the interconnected nature of SUD and mental health conditions.

Pharmacy Times: How has the role of psychiatric pharmacists in substance use disorder (SUD) care evolved in recent years?

Ashley Maister, PharmD, BCCP: I think in terms of what I’ve seen from student to resident trainee and then as my own independent practitioner, I think that the role has been more integrated. I think that when we were trainees, a lot of it was naloxone dispensing, counseling, and ensuring that people knew how to use the device. While that’s still really important, I do think that right now psychiatric pharmacists are having more of a seat at the table, if you will, with regard to helping to manage medications for opioid use disorder, alcohol use disorder, or substance use disorders in general. I think that the actual clinical patient care, or direct patient care, has been what’s evolved, at least during training and now as my own independent practitioner.

Aaron Salwan, PharmD, MPH, BCCP: What I would add to that, too, is it does seem, speaking to the integration now, it’s occurring where it didn’t occur in the past maybe five or 10 years. You’re having pharmacists manage Suboxone and buprenorphine therapy. They’re initiating treatment and they’re adjusting treatment. One role I think that I’ve seen that has become more important from a psychiatric pharmacist point of view is the utilization of long-acting injectable products. Now we have various buprenorphine products, as well as extended-release naltrexone, which are indicated for opioid and alcohol use disorders.

From an education point of view, pharmacists are not only educating patients about these as options, but they’re also guiding physicians on the appropriate choice of agent based on the patient’s history, what they’ve responded to in the past, co-occurring conditions, and things like that. I love what you said about having a seat at the table. It seems like we are looked to more now than we had been previously, specifically for initial treatment recommendations and managing various withdrawal syndromes. We’re facing a lot of very challenging substances in the environment or in the community now, so psychiatric pharmacists have to be creative, knowing how those substances work and knowing the medicines that we have available that can counter the withdrawal effects.

Pharmacy Times: What aspects of psychiatric pharmacy training uniquely prepare pharmacists to manage SUD and co-occurring mental health conditions?

Salwan: I think it’s the fact that as a psychiatric pharmacy resident, you are seeing substance use disorders on a daily basis, regardless of what setting or rotation you’re practicing in. It’s so intermixed between serious mental illnesses, anxiety, and depression that it’s hard to avoid it. Because of that exposure, you understand how to communicate as a human toward people who have these substance use disorders. You see them very early on in your training as just another patient, just another human that you’re trying to take care of.

I think that takes away some of the polarizing views and opinions that you may come to training with. That’s something I was fortunate to observe as a student, as a fellow, and as a resident, and I try to pass on that experience to any learner I have. These folks are very much like you and me. We are a handful of poor decisions away from being in their shoes, and I think that really normalizes the experience and improves the pharmacist’s ability to take care of the patient.

Maister: The only thing I’ll add is that I really liked what Aaron said about being forced to be exposed to it, because it’s something that, in some capacity, patients are dealing with or living with. When we think about substance use disorders, that also includes tobacco and nicotine use, and it also includes cannabis use. It’s not always opioids, and it’s not always alcohol.

By seeing people who are living with both, it prevents you from siloing them or treating one versus the other and actually integrating care. If we are treating their substance use disorder, what does this mean for their mental health, and vice versa? They’re so interrelated that you can’t treat them separately.