The opioid crisis: Origins, trends, policies, and the roles of pharmacists

• Published in: American journal of health-system pharmacy 2019-03, Vol.76 (7), p.424-435
• Main Authors: Chisholm-Burns, Marie A, Spivey, Christina A, Sherwin, Erin, Wheeler, James, Hohmeier, Kenneth
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - adverse effects; Counseling; Direct-to-Consumer Advertising - legislation & jurisprudence; Drug Utilization Review - organization & administration; Health Policy; Humans; Inappropriate Prescribing - adverse effects; Inappropriate Prescribing - legislation & jurisprudence; Inappropriate Prescribing - prevention & control; Medication Therapy Management - organization & administration; Naloxone - therapeutic use; Narcotic Antagonists - therapeutic use; Opioid Epidemic - etiology; Opioid Epidemic - prevention & control; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - etiology; Opioid-Related Disorders - therapy; Pain Management - methods; Pharmaceutical Services - organization & administration; Pharmacists - organization & administration; Prescription Drug Misuse - adverse effects; Prescription Drug Misuse - legislation & jurisprudence; Prescription Drug Misuse - prevention & control; Professional Role; United States - epidemiology
• ISSN: 1079-2082; 1535-2900
• DOI: 10.1093/ajhp/zxy089

Abstract Purpose The purpose of this review is to (1) provide information concerning the opioid crisis including origins, trends, and some important related laws/policies; and (2) summarize the current involvement and impact of pharmacists in helping to address the crisis, as well as examine practices in other healthcare disciplines from which pharmacists might derive guidance and strategies. Summary Contributors to the opioid crisis included campaigns to treat pain as a fifth vital sign and to use opioids in treatment of non-cancer-related pain, as well as aggressive marketing of opioid analgesics by pharmaceutical companies. To address the crisis, numerous strategies have been implemented at the policy/legislative, health-system, and patient levels, such as prescription drug monitoring programs (PDMPs), increased regulation of pain clinics, and expanded use of naloxone. Pharmacists have a critical role to play in interventions to address opioid misuse and reduce harm resulting from misuse. Such interventions include patient screening and risk stratification, patient and community education and outreach concerning appropriate pain management, medication reviews/medication therapy management, education on safe storage and disposal, distribution of naloxone/opioid rescue kits and training on their proper use, and referral of patients to addiction treatment, among other strategies. Conclusion Pharmacists have multiple, complex roles in addressing the opioid crisis. Outcomes of several studies provide substantial evidence that pharmacists can make an impact through appropriate pain management, use of PDMPs, opioid overdose prevention training, and medication reviews and counseling, among other interventions.