Expert Q&A: Role of Pharmacists in Fighting Opioid Epidemic

Wednesday, September 27, 2017

As the opioid epidemic has reached a crisis in the U.S., health care providers have been weighing in on strategies for reversing the epidemic. Lucinda L. Maine, PhD, RPh, executive vice president of the American Association of Colleges of Pharmacy, thinks pharmacists can play a larger role in helping to end the growing opioid addiction problem.

WebMD: If there is one thing you could do stop the opioid epidemic what would it be?

Maine: I would set in motion consumer education and practitioner education to limit the inflow of opioids into our communities. I do think that it is unmanaged, excessive use (of opioids) in the case of some primary patients  but also it’s, ‘I will leave that in my medicine cabinet in case I need it later.’ …And my grandson’s buddy or someone else finds it because drug seekers know where people keep unused medicine. That leads to one more person to have the potential to continue their use and route onto addiction. Closely related to that (is that) we obviously do need earlier detection and better treatment for those people that have become addicted.

WebMD: In terms of limiting access, what is the best solution?

Maine: I think it’s mostly policy. Our clinicians that prescribe pain medication became too comfortable going to opioids first when there are other situations where non-addictive, non-controlled substances appropriately used, probably would help manage acute pain. I had a foot surgery 3 years ago and….the podiatrist asked me two times, ‘Now let me ask you Lucinda, do you have any issues related to pain?’ That was his way of giving me an opportunity to tell him that I shouldn’t be prescribed an opioid. Which I thought was very clever. Maybe a little too subtle. But then he insisted upon giving me a prescription. His point was, ‘You know when the anesthetic wears off, you are going to experience pain. If that is in the middle of the night, I don’t want you to have to wait to get relief.’ …I think we also know if someone gets into a pain syndrome, it is much more difficult to treat it effectively than it probably would have been to prevent (the pain).

WebMD: What role do pharmacies play in managing the epidemic?

Maine: While the average pharmacist isn’t a pain specialist, there are an increasing number of pain specialists who are pharmacists…. Our continuing education is becoming stronger which equips the pharmacist to be a better consultant on the best therapeutic approach for a given patient’s pain. (They can also) educate patients and their caregivers on the risks and the proper approach to pain management, including the wide array of the over-the-counter medicines that are and should be adjunctive, if not primary. I think they can be a point of first contact if (the drug) I have currently isn’t working. In general, a pharmacist is easier to get to than… my prescribing physician to just trouble shoot, if this particular dose of pain medicine isn’t working or causing me side effects, (such as) nausea and vomiting. And then they are important in that process of making sure that the prescriptions that do leave and get into patients’ hands are appropriate and legitimate

WebMD: So you think it is the responsibility of the pharmacist to make sure the person’s pain is legitimate?

Read the full Q&A at 

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Laurie MacCaskill, a seven-year pancreatic cancer survivor