FrameworkLTC

View Original

Caring for the Most Vulnerable

The Role of Long-Term Care Pharmacy in Combatting the Opioid Crisis 

The opioid epidemic is one of the most serious threats facing the nation today.  In 2022, opioid overdoses claimed the lives of over 100,000 people in the United States.  Amid the rise in fatal and non-fatal opioid overdoses, pharmacists in the long-term care (LTC) sector are playing an increasingly prominent role in providing access to medications such as buprenorphine and naloxone.  This article will explore trends and opportunities for LTC pharmacies in treating opioid abuse and preventing overdose. 

Buprenorphine 

In response to the growing need for treatment options for those who struggle with opioid use disorder (OUD), there are roughly 2,000 clinics and rehabilitation centers of care in the US that provide medication-assisted treatment (MAT), such as methadone, naltrexone, or buprenorphine.   

Methadone treatment for OUD is unique in that it is strictly regulated by the federal government and can only be dispensed to patients in an opioid treatment program (OTP).  This regulation means that pharmacies are not typically involved in methadone treatment for OUD.   

Unlike methadone, buprenorphine can be dispensed to patients to treat OUD, regardless of setting.  Before the COVID-19 pandemic, buprenorphine prescribing was limited to practitioners who had applied for and obtained a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA).  This requirement was eliminated by the Drug Enforcement Administration (DEA) in January 2023.  Pharmacies no longer need to verify a prescriber’s X-DEA number to confidently dispense buprenorphine. Any prescriber with a DEA registration that includes Schedule III can prescribe buprenorphine for the treatment of OUD.  This move by the DEA creates a drastic expansion in the availability of buprenorphine treatment.   

The increased need for OUD treatment, combined with the elimination of prescribing restrictions creates a significant opportunity for LTC pharmacies serving patients in rehab, correctional, and other facilities that provide MAT for OUD.  Long-term care pharmacies are ideally situated to serve the needs of fixed-location patient populations with OUD, providing reliable access to medication 24/7, delivery service, and clinical expertise in managing the optimal use of medications.  

Naloxone 

The Food and Drug Administration (FDA) approved the first over-the-counter (OTC) version of naloxone in March 2023.  Available as a 4mg nasal spray, OTC naloxone is a powerful new weapon in preventing death from opioid overdose.  In addition to the FDA’s approval for OTC use, many state-level regulations have magnified the impact of this event by expanding pharmacists’ authority to prescribe and dispense naloxone and other opioid antagonists.  These actions place the role of the pharmacist front and center in the battle against opioid overdose. 

Naloxone is a potent opioid antagonist that rapidly attaches to opioid receptors in the central nervous system.  When administered, it blocks and reverses the effects of opioids.  The availability of naloxone can be lifesaving in an overdose situation, where an individual’s breathing has slowed or stopped due to opioid overdose.   

In long-term care, naloxone can play an important role in safeguarding the lives of residents and facility staff.  If a resident or staff member experiences an opioid overdose, whether intentional or unintentional, the availability of naloxone can mean the difference between life and death.  In the healthcare sector, the diversion of controlled substances is a reality that cannot be ignored.  The Institute for Safe Medication Practices (ISMP) estimates that 10% of all healthcare workers misuse drugs during their careers.  Furthermore, the incidence of workplace overdose deaths increased by 536% between 2011 and 2021.   

LTC pharmacies can protect the health and safety of residents and support staff by providing naloxone, along with education and training.  Inform your facility partners about the importance of keeping naloxone on hand in case of an opioid overdose emergency.  Remind them that all states have naloxone access laws that protect individuals who provide naloxone to an overdose victim.  Pharmacies can also host educational sessions, to provide instructions for naloxone use and answer questions from facility staff and residents.   

Summary 

The opioid crisis continues to challenge the healthcare system, and long-term care pharmacies can play a pivotal role in saving lives and supporting recovery through the provision of essential medications and information.  Pharmacists are the “medication experts” and can use this knowledge to help prevent, treat, and mitigate the effects of opioid overdose.  As federal and state laws continue to expand the role of the pharmacist in addressing the opioid epidemic, LTC pharmacies can leverage these new opportunities to provide a higher level of care and a glimmer of hope. 

 If you, or someone you know, is struggling with addiction – call the SAMHSA National Helpline 1-800-662-4357 

References: 

https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/07/opioid-treatment-programs-a-key-treatment-system-component#:~:text=Of%20the%20nearly%201%2C700%20OTPs,all%20three%20medications%20for%20OUD

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798325 

https://www.acponline.org/advocacy/acp-advocate/archive/february-10-2023/elimination-of-x-waiver-removes-major-barrier-to-opioid-use-disorder-treatment#:~:text=On%20Jan.,buprenorphine%20for%20opioid%20use%20disorder

https://www.gao.gov/products/gao-21-248 

https://www.ismp.org/resources/controlled-substance-drug-diversion-healthcare-workers-threat-patient-safety-part-i#:~:text=One%20in%2010%20healthcare%20workers,drugs%20rather%20than%20illicit%20drugs

https://www.jointcommission.org/-/media/tjc/newsletters/quick_safety_drug_diversion_final2pdf.pdf 

https://injuryfacts.nsc.org/work/safety-topics/overdose-deaths/ 

https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray#:~:text=Today%2C%20the%20U.S.%20Food%20and,for%20use%20without%20a%20prescription