by Bethany DiPaula, PharmD, BCPP, FASHP
Board of Pharmacy Specialties
Psychiatric Pharmacy Specialty Council Member
Professor and PGY2 Psychiatric Pharmacy Residency Director
University of Maryland School of Pharmacy
The US faces an opioid epidemic which has spanned decades – and the COVID-19 pandemic has only exacerbated this crisis. In December of 2020, the Health Alert Network issued an advisory that overdose-related deaths were at the highest number ever recorded in a 12-month period.[1] Even more disconcerting is the limited access to care for many patients with substance use disorders (SUD). Board Certified Psychiatric Pharmacists (BCPPs) have unique training and expertise to provide much needed direct patient care for this patient population. We can play an essential role in expanding access and improving patient outcomes.
Naloxone can be administered by a community bystander to reverse an opioid overdose and is an important tool in combatting the rising over-dose related deaths. Throughout the US, access to this lifesaving antidote has been expanded by pharmacists’ ability to prescribe or to directly dispense naloxone to the community under standing orders or collaborative practice agreements.[2] Pharmacists routinely provide education on the signs and symptoms of overdose and naloxone administration instructions. In addition, we are critical in offering other harm reduction strategies such as fentanyl testing kits, pre-exposure prophylaxis (PrEP), and sterile syringes. For several years, I taught the opioid overdose response program at a local health department, often to county employees and family members from the community. My experience as a Board Certified Psychiatric Pharmacist (BCPP) contributed to lively and valuable discussions and ultimately resulted in 900 community members becoming trained to save lives.
Board certified pharmacists routinely deliver care to patients with opioid use disorder (OUD) and other SUD. For years, I have provided medication management services to patients diagnosed with SUD. Many of my patients are treated with buprenorphine/naloxone or XR-naltrexone and require weekly to monthly monitoring in the outpatient setting. Psychiatric comorbidities are common and can further complicate patient management. Working collaboratively with physicians and other team members has allowed for expansion and optimization of care for a patient population that is often underserved and undertreated for multiple reasons. In many states, pharmacists are able to administer injectable medications, such as XR-naltrexone, which further expands the direct patient care role.
September is Recovery Awareness Month and Depression & Mental Health Awareness Month falls in October. SUDs are highly stigmatized, not just by the public, but by healthcare professionals as well. Pharmacists must be aware of how attitudes and misinformation can affect treatment. OUD is a brain disease and can be chronic. Medications, such as buprenorphine/naloxone, methadone, and naltrexone, are evidence-based and should be routinely prescribed without arbitrary treatment limits.
I am passionate about working with patients diagnosed with SUD and believe that pharmacists, especially Board Certified Psychiatric Pharmacists, play an essential role in improving patient care!
[1] CDC Health Alert Network Advisory December 17, 2020. https://emergency.cdc.gov/han/2020/han00438.asp. Accessed 09/27/2021.
[2] The Network for Public Health Law. Legal interventions of reduce overdose mortality: naloxone access laws. https://www.networkforphl.org/wp-content/uploads/2021/05/NAL-Final-4-29.pdf. Accessed 10/04/2021.
