Linda Simoni-Wastila, BSPharm, MSPH, PhD, professor and vice chair of research for the Department of Pharmaceutical Health Services Research (PHSR) at the University of Maryland School of Pharmacy, recently participated in an interdisciplinary task force led by researchers at the Johns Hopkins Bloomberg School of Public Health to publish recommendations aimed at curtailing the prescription opioid abuse epidemic in the United States. Sponsored by the Clinton Foundation, the report — titled “The Prescription Opioid Epidemic: An Evidence-Based Approach”– offers a number of measures that can be implemented across health care providers and settings to ensure opioids are correctly prescribed and used only as intended.
“Prescription opioids play an important role in improving the quality of life for many patients who live with acute or chronic pain,” says Simoni-Wastila, who joined the task force to provide her expertise on prescription drug policy as related to prescription drug abuse and diversion — a topic on which she has conducted research for more than 15 years. “However, studies have shown that these medications are often prescribed in excessive amounts, and in many cases, for conditions that are outside of the evidence base. The comprehensive guidelines developed by our task force focus not only on preventing new cases of opioid addiction, but also on identifying the early signs of addiction and ensuring that individuals struggling with addiction have access to effective treatments, while also safely meeting the needs of patients who depend on these medications for pain relief.”
Opioids have been shown to provide significant pain relief for many patients when used as prescribed. Although these medications were initially only prescribed to patients with cancer, they became more widely used for other chronic and acute diseases and conditions in the late 1990s, but their addictive potential was significantly underestimated. The Centers for Disease Control and Prevention now notes that prescription opioid sales have increased 300 percent since 1999, and estimates that more than 16,000 people died as a result of overdoses related to prescription opioids in 2013 – four times the number from 1999.
The report developed by Simoni-Wastila and her colleagues on the interdisciplinary task force, which included representatives from the fields of medicine, pharmacy, injury prevention, and law, as well as patient representatives, insurers, and drug manufacturers, divides its recommendations into seven categories. In addition to calling for more stringent oversight of clinical prescribing, mandatory use of prescription drug monitoring programs, and expanding the availability of naloxone – which can reverse the effects of an opioid overdose if administered correctly – the experts advocated for expanding the role of pharmacies and pharmacy benefits managers to help curb the prescription opioid epidemic.
“There are many ways that pharmacies and pharmacy benefits managers can help reduce the incidence of inappropriate prescribing and intervene when patients abuse, sell, or give others their prescription opioids,” says Simoni-Wastila. “In particular, pharmacies can encourage the use of e-prescribing, which has been shown to reduce the number of forged or fraudulent prescriptions. Pharmacy benefits managers can also remove prescriber dispensing privileges and allow pharmacists to provide counseling for patients with controlled substance dependence.”
The report issued by the task force also examines how pharmacies and pharmacy benefits managers can support research into new controlled substance interventions, identify individuals who are at risk for opioid abuse or in need of addiction treatment, and improve the management and oversight of patients who use prescription opioids. Other recommendations included encouraging pharmacies and pharmacy benefits managers to support restricted recipient (lock-in) programs, participate in prescription drug take-back programs, and improve overall monitoring of pharmacies, prescribers, and beneficiaries.
“Prescription opioids have a high potential for abuse, sometimes leading to serious and even life-threatening adverse events when not taken as prescribed,” says Simoni-Wastila. “The goal of the task force was to review existing information about prescription opioid misuse, abuse, addiction, and overdose and identify strategies that could help reverse current trends in injuries, addiction, and deaths from these drugs. While the recommendations published in our report are a great step forward in our work to ultimately put an end to this devastating public health crisis, we recognize that there is still much work to be done.”