Innovations-Magazine-October-2022 - 10

mental illness co-morbidities being more evident than in the past. "
Specifically, Jenkins explains that stimulant use is introducing new
problems. Jenkins cites " behavioral consequences " as an example of
these problems, including neurological deficits, suicidal ideation,
psychosis, hostility, and violence. Other complications include fewer
available treatments and greater difficulty accessing services. Jenkins
notes that these new challenges compound existing issues, particularly
in rural areas due, in part, to a scarcity of behavioral health resources.
In July 2022, Jenkins joined more than 20 other researchers to
outline the findings of the Rural Opioid Initiative (ROI), which
collected data by surveying more than 3,000 people who use drugs in
eight geographically diverse regions to better understand and address
rural opioid use. Of those surveyed, 86% reported using opioids (most
often heroin) and 74% reported using methamphetamine within the
prior 30 days. More than half had experienced homelessness within the
previous six months, and 49% said they had experienced an overdose
in the past. Only 48% reported ever receiving medication for opioid
use disorder (OUD). ROI is now involved in a second stage of data
collection regarding the use of seven different interventions, including
expansion of harm reduction services in underserved areas.
The rise in misuse of multiple substances is dangerous for several
reasons. First, while effective medications for OUD exist, there is a lack
of comparable treatments for stimulant addiction. Further, combining
opioids with other drugs increases the risk of overdose and can alter the
physiology of an overdose in ways that may reduce the effectiveness of
naloxone, the medication that can reverse the respiratory suppressing
effects of an opioid overdose.
Combining stimulants and opioids is not a new phenomenon, but
complications related to the continued rise in fentanyl availability
and the COVID-19 pandemic appear to be making an already
growing problem worse. This " fourth wave " of the epidemic is
having a particularly sobering impact in rural communities, but they
are not alone. Another study published in the American Journal of
Epidemiology in 2022 found that while overdose deaths from opioids
and stimulants rose across all racial groups and across the country,
opioid and stimulant deaths among Black Americans increased at
a significantly faster pace. Researchers compared trends in overdose
mortality from 2007 to 2019 by race and ethnicity group, drug type,
and state and found a 575% increase in cocaine and opioid mortality
in Black people versus a 184% increase in White people. Analysis
also found significant increases in combined opioid and stimulant
deaths among Hispanic and Asian Americans. Similar findings by Pew
Research Center found that the drug overdose death rate among Black
men more than tripled from 2015 to 2020.
Federal Agencies Put More Emphasis
on Harm Reduction
Regulators and legislators at all levels continue to take steps to respond
to the opioid crisis, even as it transforms every few years. Of particular
note for boards of pharmacy are the ongoing efforts that have been made
to reduce prescription drug abuse since the first wave of the epidemic.
These include steps to further secure the drug supply chain to limit
diversion and foster implementation and utilization of prescription
monitoring programs (PMPs) to make it easier to identify patients who
may be engaging in prescription drug abuse. More broadly, however,
some agencies and other stakeholders are emphasizing harm reduction
programs as a way to save lives.
Harm reduction is an approach that emphasizes directly engaging
with people who use drugs to prevent overdoses, prevent or reduce
other health complications related to drug use, and to make it easier to
access treatment and other health care services. At the federal level, many
agencies have taken steps to make funding more readily available for
such programs. For example, the Substance Abuse and Mental Health
Services Administration (SAMHSA) has awarded 25 grants to state,
local, tribal, and territorial governments, tribal organizations, nonprofit
community-based organizations, and primary and behavioral health
organizations, as authorized by the American Rescue Plan. Through
the grants, $30 million will be distributed between 2022 and 2025.
As another example of federal action in this area, in April 2021,
CDC and SAMHSA announced that federal funding could be
used to purchase rapid fentanyl test strips that can help identify
when drugs are mixed or cut with fentanyl. Although 19 states
continue to criminalize possession of these test strips, they may
help prevent overdoses, as many people who overdose on fentanyl
do not even know that the drug they are taking contains this
potent opioid, which can be deadly in even small amounts.
Harm reduction efforts have also been made at the state and local
levels. In New York, for example, the state health commissioner issued a
statewide pharmacy standing order for naloxone that will allow them to
stock and distribute naloxone to patients without a prescription.
NABP Initiatives
NABP has also continued its efforts to reduce harm at all levels, such as
continuing to promote pharmacist-provided medication for treatment
of patients with OUD. This initiative includes supporting the federal
Mainstreaming Addiction Treatment Act (MAT Act), which passed in
the House of Representatives in June 2022. If signed into law, the bill
will make it easier to prescribe certain medications for OUD, and allow
states to recognize pharmacists as medication treatment providers for
OUD. (See page 2 for more information about the MAT Act.) In a letter
sent to congressional leadership in June 2020, NABP has asked that
Congress consider NABP as a potential resource when considering such
public health legislation impacting the practice of pharmacy.
Other efforts to address the opioid epidemic include the support of
NABP PMP InterConnect®
as a means to expand pharmacists' access to
PMP data across state lines and ongoing consumer outreach initiatives,
such as media campaigns and regular updates to the Association's
consumer-facing website, safe.pharmacy. NABP will continue to keep its
member boards informed of new developments in the opioid epidemic
and their impact on pharmacy practice and regulation.
http://safe.pharmacy
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