Pharmacist filling a pill bottle.

Over the last decade, the number of prescription drug overdose deaths has quadrupled.

Every 25 minutes, someone loses their life to a prescription drug overdose; and in 2012, drug overdoses were the leading cause of injury death among 25-to-64 year olds. Americans abuse prescription drugs more than cocaine, heroin and hallucinogens combined, according to the Substance Abuse and Mental Health Services Administration and with overdose-related deaths continuing to soar upward in recent years, the Centers for Disease Control and Prevention (CDC) is attempting to put a stronger emphasis on treating the root of the problem.

In an effort to assist pharmacists as the last line of defense in curbing the epidemic, the CDC plans to improve data quality and surveillance to monitor and respond to the epidemic, strengthen state efforts by scaling up effective public health interventions, and supply health care providers with the data, tools and guidance needed to improve the safety of their patients. To do this, the CDC is requesting an increase of $54 million in 2016 to fund prescription drug overdose and heroin prevention efforts to all 50 states. We sat down with Bree Watzak, Pharm.D., BCPS, assistant professor of pharmacy practice at the Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy and a practicing pharmacist in College Station, Texas, to find out more about prescription overdose and the CDC’s latest initiative.

Q: What programs are currently in place for prescription drug overdose monitoring?

A: There is a prescription drug-monitoring program in Texas, but it only applies to this state and is optional for providers to utilize this tool. For example, if I need to see whether a patient picked up a prescription in Louisiana, I would have to get authorization to check Louisiana’s database, which is obviously burdensome for pharmacists and physicians alike. The National Association of Boards of Pharmacy has been working to link all 50 states so that pharmacists in Texas, Louisiana or Oklahoma don’t have to check three separate databases. A database spanning the entire country will help health care providers reduce inappropriate prescribing by allowing physicians to weed out those patients who may have addiction problems, seeking drugs for which there is no legitimate medical need. Ultimately, this would reduce the number of inappropriate prescriptions and diminish the overall risk of overdose. The CDC is hoping to establish – and link – drug-monitoring programs in all 50 states.

Q: What is currently being done to help those who are addicted?

A: This is an area that needs further development. Given the structure of the health care system, it is very difficult for prescribers and pharmacists to screen patients for potential drug abuse. This is due to the high volume of patients seen everyday, oftentimes in settings that don’t afford much privacy.

As educators, we train future physicians and pharmacists to recognize the signs and symptoms of addiction, but it is often difficult to put into practice. Each hospital and pharmacy has its own guidelines for screening patients, but the CDC is establishing new and more uniform standards. Having well-established guidelines will help pharmacists and prescribers recognize and stop abuse more often.

Q: What will the CDC initiative ultimately do?

A: Some strategies recommended by the CDC are implementation of innovative insurance programs, state-run databases that track prescriptions to determine any over-prescribing problems and public health outreach programs aimed at educating physicians, pharmacists and the public about prescription overdose.

Part of the CDC’s initiative is to encourage insurance companies to provide payment for addiction treatments. Currently, most insurance policies don’t cover the cost for recovery, causing people to pay for treatments out-of-pocket and take time off from work. However, many employers do not allow time off for such instances, causing some to lose their jobs while getting treated. It’s a terrible cycle, which the CDC is hoping to end by implementing innovative insurance.

Additionally, expanding the prescription drug-monitoring program to all 50 states will allow pharmacists to track potential high-risk patients. Currently, 49 states and Washington, D.C., each have monitoring programs; however, each monitoring program is independent of those in other states. The National Association of Boards of Pharmacy is trying to create a comprehensive monitoring program that will make it easier for pharmacists to monitor potential abusers across state boundaries, decreasing the chance for abuse.

Educating the public is a critical step as nearly 110 Americans die every day from drug-related overdoses, and about half of those overdoses are related to opioids. More than two-thirds (70 percent) of people who misuse prescription painkillers for the first time report obtaining the drugs from friends or relatives, including from the home medicine cabinet; these incidences can be somewhat minimized through public education and awareness. The CDC is in the process of developing public health programs and campaigns to spread awareness.

Q: Will these initiatives and policies make it more difficult for patients to obtain prescriptions?

A: Physicians and pharmacists are trying to preserve opioids for people who have legitimate pain and not let them get into the hands of people who are abusing them. The U.S. Drug Enforcement Agency (DEA), responding to the 2012 Food and Drug Administration Safety and Innovation Act, reclassified hydrocodone combination medications in October from Schedule III to Schedule II.  Schedule III drugs are defined as drugs with moderate to low potential for abuse, whereas Schedule II drugs are defined as drugs with a high potential for abuse. The goal is that people who legitimately need medications for pain still receive it, but those who were simply abusing the opioids will find them more difficult to obtain.

A: Are pharmacy students being taught methods to alleviate prescription drug overdoses?

A: Texas A&M Rangel College of Pharmacy has multiple avenues for preparing students to combat prescription drug abuse that leads to overdoses. One example is an elective rotation in substance abuse at the South Texas Substance Abuse Recovery Services in Corpus Christi. Students who take this course gain an appreciation of the disease model of drug addiction. This six-week rotation gives students a glimpse of the other side of drug addiction: the illicit use of both prescription and street drugs.

There are many opportunities for Texas A&M pharmacy students to learn the signs of potential addicts or distributors of prescription drugs, and what to do should they suspect a patient is abusing prescriptions, but this training is not mandatory to receive their pharmacology license. Part of the CDC’s initiative will certainly involve more training and screening guidelines for both pharmacists and prescribers.

Watzak teaches drug addiction courses and takes Texas A&M pharmacy students to a week-long program on alcoholism and other drug dependencies at the University of Utah School of Medicine each summer.

— Elizabeth Grimm

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