Bethany DiPaula, PharmD, BCPP
Chair, CPNP Substance Abuse Task Force
Associate Professor University of Maryland School of Pharmacy
Director of Pharmacy Springfield Hospital Center
Raymond C. Love, PharmD, BCPP, FASHP
Professor, University of Maryland School of Pharmacy
Director, Mental Health Pharmacy Program, Maryland Behavioral Health Administration
Every day, the local and national media call attention to the growing epidemic of opioid misuse. Over 16,000 people died from prescription opioid overdoses in the United States in 2010. Worldwide, 69,000 people per year die of opioid overdose. In April 2014, CPNP created a Substance Abuse Task Force (SATF) charged with developing a vision and plan for psychiatric pharmacist services in opioid use disorders, focusing on buprenorphine prescriptive authority and naloxone rescue.
The Task Force began by developing a mission, vision and talking points to be used by SATF members as they reach out to potential partner organizations, legislators and regulators. They then developed a list of potential partners and key contacts to assist them in their efforts to increase patient access to naloxone and address the shortage of prescribers for buprenorphine.
One partner identified by the SATF is the Providers’ Clinical Support System for Opioid Therapies (PCSS-O), a consortium of major stakeholders and constituency groups with interests in safe and effective use of opioid medications. PCSS-O offers training and colleague support in the treatment of substance use disorders. Funded by SAMHSA, they produce free educational material on the safe and effective treatment of chronic pain and opioid use disorders. PCSS-O is eager to enlist pharmacists as partners in its efforts. In November, the CPNP Board agreed to make application to join PCSS-O as a participating organization. The Board and the SATF are eager to use this partnership as an opportunity to demonstrate the valuable contributions pharmacists can make in the treatment of substance use disorders.
In the Spring of 2014, the Senate Health Education, Labor, and Pensions (HELP) Work Group on Prescription Drug Abuse was formed. This is a bipartisan staff working group created to address the challenges of prescription drug abuse. The SATF worked with the Board to contact the work group and offer SATF as a resource in their efforts.
As SATF members investigated opportunities to expand the role of the pharmacist in substance abuse treatment, they discovered the existence of a bill in the US Congress not involving organized pharmacy. The Recovery Enhancement for Addiction Treatment Act (S. 2645, TREAT Act) is proposed legislation which would expand the existing DATA2000 to allow healthcare professionals other than physicians to prescribe buprenorphine for opioid dependent patients and would increase the maximum number of patients that are managed by all certified physicians from 30 to 100. CPNP Board representatives Drs. Steve Burghart and Ray Love and SATF Chair Bethany DiPaula met with the national associations representing nurse practitioners and physician’s assistants to discuss the role pharmacists might play within the TREAT ACT or similar legislation. Yet another opportunity reviewed by the SATF was S. 1657, proposed legislation by Senator Tom Udall. This proposal also would create an expansion of prescribing authority for opioid treatments. Neither proposal has been scheduled for hearing by the respective Congressional committees.
Pharmacists are well aware that naloxone rescue can be a lifesaving strategy for managing opioid overdose. Naloxone rescue has been endorsed by the White House Office of National Drug Control Policy. Subsequently, prescribing of naloxone for administration by non-health professionals in the community is increasing dramatically. Some US states now allow pharmacists to prescribe or dispense naloxone under standing orders. However, community pharmacists may be unfamiliar with naloxone’s unique ordering and administration challenges. As states and organizations develop naloxone rescue programs, there is a need for concise and focused information on this topic. Consequently, the SATF is completing work on naloxone rescue guidelines that address issues encountered by naloxone rescue programs in order to provide pharmacists with the information they need to participate in these efforts.
The SATF is made up of a group of enthusiastic and hardworking CPNP members. We are excited to be serving our organization and the public. Please feel free to contact any of the members with questions or suggestions!