By: Katharine Russo, PharmD Candidate c/o 2021
The DEA announced in August 2017 that 2018 would bring strict manufacturing reductions to commonly prescribed schedule II opioid painkillers. As the opioid epidemic continues to take countless lives, the government, including President Donald Trump are cracking down on regulations. Under this directive, there will be a 20 percent decrease in the manufacturing of controlled substances as compared to 2017 for the following medications: oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, meperidine, and fentanyl.
Each year, the epidemic plaguing our nation continues to worsen. Every 24 hours, 91 lives are lost to an accidental opioid overdoes.1 In 2015, 52,4042 deaths were attributed to lethal drug overdoses stemming from addiction.2 Of those 52,404 deaths, 33,091 overdose deaths were related to schedule II narcotics.2 In 2015 alone, New York State witnessed a 135.7 percent increase in synthetic opioid death rates vs 2014.2 The FDA states that since 1999, the number of opioid related overdoses resulting in death, including those by heroin, has quadrupled.1 However, the number of opioid related deaths involving prescription opioids has more than quadrupled.1 With the urgent need to curb this epidemic, various public health and governmental responses have been put into place. Such public health responses include the more accessible lifesaving antidote, naloxone, and an increase in State Prescription Drug Monitoring Programs.
Naloxone (Narcan®) is a highly effective emergency medicine for opioid overdoses. Due to the escalating epidemic, it is suggested that family members, friends of opioid users, and all healthcare professionals be trained to administer this life-saving medication. Administering this drug to patients experiencing an overdose, or those assumed of having an overdose, reverses the effects of the opioid. Naloxone attaches to the same receptors in the brain that bind opioids and blocks the effects of opioids for 30 to 90 minutes to reverse the respiratory depression that ultimately leads to death. Naloxone will only work against opioids such as heroin and opioid painkillers, but it will not hurt the patient if any of these opioids are not involved but an overdose is still suspected.3
Another initiative to help curb the opioid epidemic is the implementation of Prescription Drug Monitoring Programs (PDMP). PDMPs are tools utilized by the government for reducing prescription drug abuse and diversion of medication to the streets. This program is utilized by collecting, monitoring, and analyzing electronically transmitted prescribing and dispensing data submitted by pharmacies and approved dispensing physicians. The purpose is to monitor the distribution of controlled substances to safeguard the public while supporting the legitimate use of controlled substances for medical conditions. There are currently 49 states, the District of Columbia, and Guam that have PDMPs. New York State collects information for Schedule II-V whereas some states that only collect for Schedules II-IV.4
Within the past few weeks, President Donald Trump has called this crisis a national emergency. In an official White House statement, the President has authorized his administration to use any and all appropriate emergency measures to respond to the opioid crisis.5 The Drug Enforcement Administration, a government entity, has proposed to reduce the amount of manufactured Schedule II drugs in 2018 to help regulate the amount of Schedule II narcotics available in the system. This is being done by limiting the quantities of the basic ingredients needed to meet the countries’ legitimate research, medical, scientific, industrial, and export needs of these products. 6
Pharmacists will play a big role in helping to decrease the number of opioid abuse related deaths. The Virginia State Board of Pharmacy has required all active pharmacists in their state to complete one hour of continuing education courses based on opioid abuse prevention.7 Making healthcare professionals more aware of the situation is the first step to ending this issue. As part of the profession, pharmacists play a big role in the management and counseling of pain medications. Encouraging patients, family and friends of users, or patients’ caretakers to carry naloxone is also being encouraged by the Board of Pharmacy. Pharmacists have the capability of controlling this crisis by informing patients of the dangers of opioid use, instructing them on handling suspected overdoses, and advocating for safe medication storage and disposal as to not fall into the wrong hands.8
- Understanding the epidemic. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/epidemic/index.html. Published 08/30/2017. Accessed 09/12/2017.
- New data show continuing opioid epidemic in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/media/releases/2016/p1216-continuing-opioid-epidemic.html. Published 12/16/2016. Accessed 09/06/2017.
3. Why use naloxone? Naloxoneinfo.org. http://naloxoneinfo.org/get-started/about-naloxone. Published 09/01/2013. Accessed 09/12/2017.
- Prescription drug monitoring frequently asked questions (FAQ). Prescription Drug Monitoring Program Training and Technical Assistance Center. http://www.pdmpassist.org/content/prescription-drug-monitoring-frequently-asked-questions-faq. Accessed 09/12/2017.
- Achenbach J, Wagner J, Bernstein L. Trump says opioid crisis is national emergency, pledges more money and attention. The Washington Post. https://www.washingtonpost.com/politics/trump-declares-opioid-crisis-is-a-national-emergency-pledges-more-money-and-attention/2017/08/10/5aaaae32-7dfe-11e7-83c7-5bd5460f0d7e_story.html?utm_term=.c5cfa3f93a86. Published 08/11/2017. Accessed 09/06/2017.
- DEA proposes reduction to amount of controlled substances to be manufactured in 2018. United States Drug Enforcement Administration. https://www.dea.gov/divisions/hq/2017/hq080417.shtml. Published 08/04/2017. Accessed 09/06/2017.
- Barlas S. Pharmacists step up efforts to combat opioid abuse: the CDC and Congress are trying to pitch in. P T. 2015;40(6):369-401.
- Reynolds V, Causey H, McKee J, et al. The role of pharmacists in the opioid epidemic: an examination of pharmacist-focused initiatives across the United States and North Carolina. N C Med J. 2017;78(3):202-205.