Overdose Deaths in the United States: What Can Pharmacists Do?

The National Vital Statistics System tracks drug overdose deaths within the 50 states and the District of Columbia. The Centers for Disease Control and Prevention estimate US overdose deaths hit a record 107,000 in 2021—a heart-breaking record!¹ Using this estimate, an overdose death occurs every 5 minutes. The increase began approximately 20 years ago with overdoses involving opioids, followed by heroin and—most recently—illicit fentanyl.²

The federal government introduced a national drug control strategy that calls for targeting the manufacturing and trafficking of illicit drugs, improving data systems for drugs, and providing treatment.³ Pharmacists can and should be part of this strategy. Community pharmacies are part of the fabric of health care in the United States.

Pharmacists could be a major part of the US strategy through several practice mechanisms. The first is mandatory tracking of controlled substance database programs operating across all states in the United States.^4-5 These systems provide an invaluable resource for practitioners and pharmacists to identify potential cases of drug over-utilization, misuse, and over-prescribing of controlled substances through the state. All patients with a new or renewed prescription for a controlled substance should be monitored through these systems on a regular basis. This process should be written into the pharmacy practice act for all pharmacists.⁴

Second, burprenorphine and naltrexone are considerably underused. A recent study of 921 pharmacies across 473 US counties with high rates of death from opioid-related overdoses demonstrated that 1 in 5 pharmacies refused to dispense these vital lifesaving medications that lower risk for opioid overdose. Furthermore, it was common for pharmacies to block access to naltrexone.⁶

In a separate study published in JAMA Network Open, in a sample of 179,280 participants, 57.4% of persons with opioid use disorder and 70.4% of those with substance use disorders did not receive these agents.⁷ All 50 states allow an individual to obtain naloxone without a prescription in some capacity, with many (29) providing dispensers with immunity from prosecution.⁸  Pharmacists can be reimbursed for dispensing these mediations; however, patient consultations, which would no doubt be beneficial to many of these individuals, are not reimbursed. 

The outcry for targeted interventions to prevent morbidity and mortality from medications in general remains a whisper, but the loss of life from prescription and recreational use of opioids is increasing, and we are losing an entire generation to this health care crisis. Although reimbursement certainly plays a role in pharmacist apathy in this area,⁹ the profession must advocate in a pivotal way to reduce these unnecessary deaths.

References:

1. Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics; 2022. Updated June 15, 2022. Accessed June 20, 2022. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
2. Stobbe M. US overdose deaths hit record 107,000 last year, CDC says. US News. May 11, 2022. Accessed June 20, 2022. https://www.usnews.com/news/health-news/articles/2022-05-11/us-overdose-deaths-hit-record-107-000-last-year-cdc-says
3. Johnson CK. Biden drug control plan stresses harm reduction, treatment. AP News. April 21, 2022. Accessed June 20, 2022. https://apnews.com/article/biden-science-health-medication-congress-e97c2b7ffb5bd8f79a8a1277a6b56588 
4. Utah Department of Commerce, Division of Occupational and Professional Licensing. Controlled Substance Database. Accessed June 20, 2022. https://dopl.utah.gov/csd/index.html   
5. American Association of Nurse Practitioners. Issues at a glance: prescription drug monitoring programs (PDMP). Updated October 2021. Accessed June 20, 2022. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-at-a-glance-prescription-drug-monitoring-programs-pdmp
6. Kazerouni NJ, Irwin AN, Levander XA, et al. Pharmacy-related buprenorphine access barriers: An audit of pharmacies in counties with a high opioid overdose burden. Drug Alcohol Depend. 2021;224:108729. doi:10.1016/j.drugalcdep.2021.108729
7. Xu KY, Mintz CM, Presnall N, Bierut LJ, Grucza RA. Comparative effectiveness associated with burprehrophine and naltrexone in opioid use disorder and concurring polysubstance use. JAMA Netw Open. 2022;5(5):e2211363. doi:10.1001/jamaneworkopen.2022.2211363
8. Legislative Analysis and Public Policy Association. Naloxone Access: Summary of State Laws. Legislative Analysis and Public Policy Association; 2020. Accessed June 20, 2022. https://legislativeanalysis.org/wp-content/uploads/2020/10/Naloxone-summary-of-state-laws-FINAL-9.25.2020.pdf 
9. Haggan M. Pharmacist apathy—or lack of knowledge and care factor? Australian Journal of Pharmacy. July 7, 2015. Accessed June 20, 2022. https://ajp.com.au/columns/opinion/pharmacist-apathy-or-lack-of-knowledge-and-care-factor/