The Role of Pharmacists and Prescription Monitoring Programs in Stemming the Opioid Epidemic

The opioid crisis continues to be a public health threat. According to the Centers for Disease Control and Prevention, 70.6% of all overdose deaths are attributed to opioids.¹

COVID-19 has fueled a spike in the cases of opioid overdose across the nation.² Various strategies to combat the crisis include the use of prescription monitoring programs (PMPs), increasing naloxone accessibility, opioid prescribing policies, provision of funding for treatment, and needle exchanges.

PMPs are the most widely used, having been adopted by 49 states. Literature agrees that pharmacists are best suited to play a key role in the opioid epidemic because of their accessibility, education, and their unique relationship with patients.³

Pharmacists can be instrumental in reducing the 3 main challenges in opioid use disorder—namely supply, demand, and harm. Pharmacists can contribute to reducing the supply of opioids via PMP, drug take-back programs, and dispensing within established prescribing guidelines.

Demand can be minimized by pharmacist counseling patients on non-opioid pain management options. Legislations have taken the first steps in harm reduction. All 50 states now have dispensing of naloxone by pharmacists enhancing community accessibility.⁴ Pharmacists must do their part by stocking naloxone, offering it to patients who need it, and providing the appropriate patient education.

Pharmacists have had a pronounced role in checking PMP and refusing or accepting to fill an opioid prescription. This opioid “gate keeper” role is an important defense position that prevents opioid prescription medication from flooding the streets; however, this surveillance role is a missed opportunity to play offense.

Pharmacists can use PMP as part of an opioid abuse and overdose risk screening process. There is an increase in the number of heroin overdoses that potentially stem from prescription opioid abuse and supply reduction of the drug, stemming from practices such as PMP.⁵

It is a disservice to the patient and community to refuse to fill a prescription without providing the patient with potential remedies—secondary to identifying risky opioid use on a PMP. Patients identified to be at risk for developing an opioid use disorder should receive counseling that encompasses alternatives for pain management, education on opioid use disorder, support group, and treatment options.

The opioid epidemic is surging full steam ahead especially in light of COVID-19. Pharmacists must take the next step of PMP use and not only turn patients away, but recognize, counsel, and provide resources to patients at risk for opioid use disorder.

Limitations include time, lack of compensation, and education on how to screen and communicate effectively with this patient population. These hurdles still need to be overcome; however, considering the accessibility and the trust⁶ patients place in pharmacists, the next step must be taken to use PMPs to provide effective patient care.

References

1. Drug overdose deaths remain high. CDC. Updated March 3, 2021. Accessed August 1, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.htm
2. The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward. March 25, 2020. Accessed August 1, 2021. https://www.commonwealthfund.org/blog/2021/spike-drugoverdose-deaths-during-covid-19-pandemic-and-policy-options-move-forward
3. Old drug, new life: Naloxone access expands to community pharmacies. APhA. 2015. Accessed August 1, 2017. http://www.pharmacist.com/old-drug-new-life-naloxone-access-expands-community-pharmacies
4. Naloxone access: A practical guideline for pharmacists. May 10, 2020. Accessed August 1, 2021. naloxone-access.pdf (cpnp.org)
5. Phillips JK, Ford MA, Bonnie RJ. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington (DC): National Academies Press (US); 2017 Jul 13. 4, Trends in Opioid Use, Harms, and Treatment. Available from: https://www.ncbi.nlm.nih.gov/books/NBK458661/
6. Pharmacists Rank Second Again among Gallup’s Most Trusted Professionals. NACDS. December 21, 2016. Accessed August 1, 2021. https://www.fda.gov/media/131878/download