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Cynthia A. Gutierrez, PharmD, MS, BCPP

This session can be purchased in CPNP University

In the 1990s, prescriptions for opioids increased due to a false perception that patients could not become addicted to the painkillers. The misuse of these prescription medications that ensued demonstrated that opioids indeed were highly addictive and led to the current opioid crisis. The abuse of prescription drugs and heroin in the United States has risen to epidemic levels, resulting in unprecedented rates of drug overdose and related fatalities, with more than 60% of drug overdose deaths involving an opioid. In response, the US Department of Health and Human Services declared the opioid epidemic a national public health emergency and outlined plans to combat the problem.

In his CPNP 2018 keynote session, America’s Opioid Crisis and the Role of Pharmacists, Dr. Christopher Jones, PharmD, director of the National Mental Health and Substance Use Policy Laboratory at the Substance Abuse and Mental Health Services Administration (SAMHSA), shared his research on the opioid epidemic and its sequelae.

Dr. Jones described the current statistics and trends of the current opioid epidemic and the risk factors for illicit opioid use in the United States. Over the past decade overdose deaths attributed to synthetic opioids have been increasing despite increased regulation of prescription opioids to combat misuse and/or overuse. As prescription opioids become more difficult to obtain, the use of heroin has been increasing. The dangers of contaminated and counterfeit products readily available on the streets were highlighted as reports of deaths related to contaminated products increase. Health consequences of illicit use go beyond direct risks of death due to overdose. Rates of blood borne illnesses including hepatitis C and HIV related to sharing contaminated needles have increased in correlation with escalating misuse of opioids. Further, misuse of opioids during pregnancy has led to increased rates of neonatal abstinence syndrome.

Dr. Jones presented strategies currently being utilized to address the opioid epidemic and its sequelae. Efforts are being focused on the prevention of opioid misuse, understanding and targeting of the underlying issues of addiction, and increasing access to the reversal agent naloxone. Other important components include early identification of those at risk and providing increased access to medication assisted treatment with opioid agonist therapies buprenorphine and methadone. Long-term strategies include drug development of pain medications with decreased abuse and/or addiction potential.

Pharmacists can directly impact opioid misuse by providing education to both patients and providers, serving as members of interdisciplinary teams treating those with pain and/or dependence, assisting with prescription drug monitoring and urine drug screening, and advocating for their patients.

Take Home Points

  • The misuse and addiction to opioids is a serious national health problem with the abuse of prescription drugs and heroin resulting in unprecedented rates of drug overdose and related fatalities, with more than 60% of drug overdose deaths involving an opioid.  
  • Health consequences go beyond overdose and include risk of blood born infections in those with intravenous drug use and neonatal abstinence syndrome in those born to mothers who use opioids during pregnancy.
  • Strategies to target the epidemic include increasing access to treatment, increasing access to naloxone, improving the practice of pain management, increasing research, and improving reporting of public health data.
  • Pharmacists can help by providing education, serving on interdisciplinary teams, assisting with prescription drug monitoring and urine drug screening, and most of all, serving as advocate for patients.

References

  1. US Department of Health and Human Services.  https://www.hhs.gov/opioids/about-the-epidemic/index.html
  2. Muhuri PK, Gfroerer JC, Davies MC.  Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHCQ SAMHSA, 2013.  https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-pain-reliever-use-2013.htm
  3. Carlson RG, Nahhas RW, Martins SS, Daniulaityte R. Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160:127-34.
  4. Harocopos A, Allen B, Paone D. Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City Int J Drug Policy 2016;28:106-112
  5. Broz D, Zibbell J, Foote C et al. Multiple injections per injection episode:  High risk injection practices among people who injected pills during the 2015 HIV outbreak in Indiana.  Int J Drug Policy 2018; 52:97-101.  
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