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Solving the Opioid Crisis Teach-Out

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Additional Perspectives / Lesson 4 of 5

Interview with Vicki Ellingrod, PharmD, FCCP

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Vicki Ellingrod, PharmD, is John Gideon Searle Professor, Associate Dean for Research and Graduate Education, Professor of Pharmacy, College of Pharmacy, Professor of Psychiatry, Medical School and Adjunct Professor of Psychology, College of Literature, Science, and the Arts

Dr. Ellingrod received her BS in Pharmacy (1992) and her PharmD (1994) from the University of Minnesota. She is a core faculty member of the U-M Clinical Pharmacogenomics Laboratory.

The following reading was submitted by Dr. Ellingrod in response to our questions. em>

By training, I am a psychiatric pharmacist that began my academic career as the clinical pharmacist on a medical psychiatry unit while building my mental health research program. In particular, my research focuses on identification of pharmacogenomics biomarkers for medication treatment response to psychiatric medications. Currently, I am the John Gideon Searle Professor of Clinical and Translational Pharmacy and Associate Dean for Research and Graduate Education in the College of Pharmacy. I also am a Professor in the Department of Psychiatry and an Adjunct Professor in the Psychology Department.

The opioid crisis in America is really a National public health problem that can, and does, affect anyone. There is no doubt that our communities have been flooded with opioids, and while the abundant supply is a problem, also contributing to the crisis is our society’s stigmatizing of substance abuse and mental illness. For those that become addicted to opioids, a biological physical process occurs which prevents them from successfully ceasing use without help. The stigmatizing of substance abuse can contribute to an individual not receiving help due to fear of what others in society may think. Therefore, reduction in stigma as well as programs that support addicted individuals and family members in getting help, in concert with reductions in the supply of opioids to abuse, can be part of the solution to this problem.

It has become very clear that pharmacies and pharmacists can play a role in combating the opioids use crisis, starting with helping to reduce the supply into our society. Research shows that for patients receiving an opioid for acute pain (post-surgery, dental procedure, etc.) more than two-thirds of that prescription is not used and sits within our medicine cabinets at home. This results in excess opioids being funneled into the system of abuse, as leftover medication may be stolen, sold, or abused by a family member. Recently, CVS (a national pharmacy chain) announced that it would limit the number of opioids dispensed to a 7 days’ limit for certain conditions for patients who are new to pain therapy. What this means is that for patients receiving an opioid for acute pain (those that are new to pain therapy) a 7 day supply should be adequate to treat this pain. If more pain medication is needed after this time period, then the patient would have to call their prescriber and request more. I personally have heard many misconceptions regarding this new policy and would like to clearly state that this policy is not meant to prevent patients with chronic pain needs from receiving their medications. This new policy is only meant to prevent the extra two thirds of opioids which are dispensed for acute pain, but never used, from being abused and represents one of the ways pharmacies are working to reduce the supply of opioids. In addition to making this policy change, CVS will also be purposely counseling patients about the Center for Disease Controls (CDC) guidelines for the treatment of pain, focusing on the risk of dependence and addiction, how to keep opioids secure within the home, and proper disposal of any mediation that goes unused. They are also leading efforts to increase the number of places where excess opioids may be dropped off for disposal. There is a misconception that unused prescription medications should be flushed down the toilet. This practice is problematic for many reasons and therefore any leftover medication should be brought back to the pharmacy for proper disposal.

While patient education and reducing the supply of opioids are both key to preventing new abuse, pharmacies are also working to support individuals current addicted to opioids as well as their family members. Data shows that there are approximately 4 million people in the United States that are either abusing opioids or unable to stop using them without experiencing withdrawal symptoms. Additionally, overdose deaths from opioids have increased 5 fold since 1980 with more than 60% of all drug-related deaths now being associated with opioids (Rusch LM 2016). These staggering statistics speak to the need to have readily available treatments for opioids abuse and overdose. A key component of treatment is use of medication assisted therapy (MAT) where individuals are switched from an abused substance to a different substance under the care of a healthcare professional. An example of this is Suboxone which is a combination product that is can be used for MAT. However, recent data shows that there are fewer than 30,000 physicians with prescribing privileges for Suboxone, which, given the approximately more than 4 million Americans that are either abusing or addicted to opioids, presents a significant dilemma. Therefore, in response to these staggering statistics the American College of Clinical Pharmacology has issued a policy statement and is taking active measures to provide health professional education regarding the opioid crisis and the need for expanded access to MAT as well as medications that can be used for overdose treatments such as Naloxone.

A prime example of how the state of Michigan is working to prevent opioid-related deaths is a recent law which provides Michigan pharmacies’ and pharmacists the ability to obtain a standing order to provide naloxone to Michigan families. This change to the practice of pharmacy is very significant because it allows for greater access to naloxone, which can reverse the effects of opioids and can be lifesaving in an overdose situation when administered immediately. According to the State of Michigan webpage “This standing order is intended to ensure that individuals within the State of Michigan who are at risk of experiencing an opioid-related overdose, or who are family members, friends or other persons who are in a position to assist a person at risk of experiencing an opioid-related overdose, are able to obtain naloxone.” In order to participate in this program, pharmacies do need to register; however a listing of the pharmacies that are authorized to dispense naloxone for this purpose, as well as a map of where the pharmacies are located, can be found on this webpage. As can be seen from this map there is a broad representation across the state in the number of pharmacies where naloxone is available using this standing order.

In conclusion, while education, reduced supply, and expanded access to MAT and naloxone are critical in our fight to end the opioid crisis, but so much more is needed. Working to destigmatize substance abuse and mental illness is key because research shows that not only does depression increase the risk for substance abuse, but also substance abuse increases the risk for depression. Therefore, by reducing stigma associated with both of these illnesses, those that need help can speak out and get help. And while pharmacies are not often thought of as a place to get help for mental health or substance abuse related treatments, pharmacists are often some of the most publically accessible health care professionals and therefore play a critical role in these efforts. So if you have questions about opioids, substance abuse, or mental health, talk to your pharmacist or other healthcare professional as they can help to find the resources you are looking for.

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