By: Mah Noor, PharmD Candidate c/o 2021

Although the opioid crisis began in the late 1990s, there has been a recent increase in prescription and illicit opioid drug use which has led to an increased prevalence of opioid overdoses due to misuse and dependency. In 2017, the number of overdose related deaths involving opioids, including prescription opioids like oxycodone (OxyContin^®) as well as illegal opioids like heroin and illicitly manufactured fentanyl (Duragesic^®), was six times higher than in 1999.¹ Patients who are regularly prescribed opioids may have an increased tolerance and dependency to their medications, which means they require higher and more frequent doses to maintain analgesic effects. Additionally, nearly eighty percent of heroin users reported misusing prescription opioids prior to using heroin.²

According to the Centers for Disease Control and Prevention (CDC), there have been three waves of opioid overdose related deaths. The first wave was in the 1990s and included overdose related deaths involving prescription opioids such as oxycodone, hydrocodone (Vicodin^®), codeine, morphine (MSContin^®), methadone (Methadose^®). Pharmaceutical companies, such as Purdue Pharma which manufactures oxycodone and was formerly owned by the Sackler Family, reassured healthcare providers that patients would not become addicted to prescription opioid pain relievers, and thus, propelled providers to prescribe them at greater rates, contributing to the growing epidemic. The second wave was in 2010 and consisted of rapid overdose related deaths involving heroin. The most recent wave in 2013, which led to a significant increase in overdose related deaths, was a result of synthetic opioid use, including illicitly manufactured fentanyl being sold on the streets in combination with heroin, counterfeit pills, and cocaine.³

In November 2019, federal prosecutors in New York State opened investigations on Johnson & Johnson, Teva Pharmaceutical Industries Ltd., Mallinckrodt PLC, Amneal Pharmaceuticals Inc., AmerisourceBergen Corporation and McKesson Corporation.⁴  These pharmaceutical companies are under investigation in order to determine whether they intentionally neglected regulations and promoted the sale of addictive opioids by claiming low addiction rates so that physicians would prescribe opioid medications in increasing numbers. Prosecutors sent subpoenas and requested documents from the aforementioned companies in order to better understand their marketing and sale of opioids, internal programs and policies to stop the abuse of opioid medications, and examine if the companies violated the Controlled Substances Act, which regulates federal drug distribution and possession.⁴ Although many recognize pharmaceutical companies and physician prescribing patterns as the root causes of the opioid crisis, the impact socioeconomic factors have on one’s likelihood to use and abuse opioids should not be underestimated. In socioeconomically disadvantaged communities, circumstances of life may influence individuals to turn to substance abuse. Psychological and environmental factors such as peer pressure, physical and sexual abuse, early exposure to illicit drugs, stress, and parental guidance, or lack thereof, can greatly affect one’s likelihood to use illicit drugs. Repeated drug use also makes it difficult to battle substance abuse due to chemical and psychological changes in the brain which lead to increased tolerance and changes in one’s self-control.⁵

Pharmacists are responsible for ensuring safe and effective medication use and distribution through assessing pharmacotherapy, counseling patients, and monitoring medication-use outcomes. As healthcare providers who have the most frequent and consistent interaction with patients, pharmacists should actively work to improve the way patients are prescribed pain management therapies by referring to clinical practice guidelines and tailoring regimens to each patient’s circumstances. A pharmacists’ role on the front lines of community health care makes it vital for them to be skilled at identifying patients struggling with opioid use disorder. Pharmacists have the skills to not only provide care through substance abuse prevention and assistance programs as well as educational awareness events, but also to serve in leadership positions which are focused on mitigating the opioid epidemic. Only half the world’s nations provide access to effective treatment options for opioid dependence and less than ten percent of patients who are in need of such treatment are currently receiving it.⁶ In order to make strides in the realm of opioid use disorder, healthcare professionals of all disciplines must work collaboratively to provide the knowledge and support their communities need, both medically and socioeconomically.

SOURCES:

1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics. http://wonder.cdc.gov . Published: 01/01/2017. Assessed: 01/10/2020
2. U.S. Department of Health and Human Services. “HHS.gov/Opioids: The Prescription Drug & Heroin Overdose Epidemic.” HHS.gov. https://www.hhs.gov/opioids/ .Published: 01/01/2019. Assessed: 01/10/2020
3. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;67:1419–1427. DOI: http://dx.doi.org/10.15585/mmwr.mm675152e1 . Published: 01/04/2019. Assessed: 01/10/2020
4. Hong, N. 6 Drug Companies’ Role in Opioid Epidemic Scrutinized by Prosecutors. The New York Times. https://www.nytimes.com/2019/11/27/nyregion/brooklyn-opioid-investigation.html Published: 11/27/2019. Assessed: 01/10/2020
5. NIDA. “Understanding Drug Use and Addiction.” National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction . Published: 06/06/2018. Assessed: 04/09/2020
6. Information Sheet on Opioid Overdose.” World Health Organization, https://www.who.int/substance_abuse/information-sheet/en/ Published: 08/21/2018. Assessed: 01/10/2020

Published by Rho Chi Post