Pharmacy chain works to help curb opioid epidemic

(Reuters Health) - The drugstore chain Walgreens is taking a three-pronged approach to combat the public health crisis stemming from prescription opioids, according to a team of pharmacists and other clinicians from the company.

In the Journal of the American Pharmacists Association, they report that Walgreens pharmacies have expanded access to naloxone, a drug that can block the effects of opioid painkillers such as hydrocodone and oxycodone and thereby prevent overdose deaths from respiratory failure.

In addition, the chain installed medication-disposal kiosks in 500 of its 8,200 U.S. stores to make it easier for Americans to empty their medicine cabinets of unused pharmaceuticals that might otherwise fall into the hands of substance abusers.

Walgreens also has employed pharmacists and students to educate and counsel patients and caregivers about opioid overdoses and naloxone.

By August 2016, the chain had dispensed 10,478 naloxone prescriptions in 49 states, the pharmacists say.

Phil Caruso, a Walgreens spokesman who was not among the authors of the report, said most health insurance plans cover the cost of naloxone - $18.99 in a syringe version and $39.99 for a nasal version.

Emily Shafer, lead author of the report, compares naloxone to the emergency treatment for severe allergic reactions, EpiPen. “It’s important to have it on hand, like (you would have) an EpiPen if someone in your household has a peanut allergy,” she said in a phone interview.

Indeed, in 2014, U.S. Attorney General Eric Holder urged federal law enforcement agencies to train first responders to treat overdose victims with naloxone.

Addiction expert Dr. Alexander Walley likened naloxone in the home of an opioid user to a fire extinguisher. “If you have a gas stove, you’re expected to have a fire extinguisher,” he said in a phone interview. “If you have opioids, you should have naloxone.”

Naloxone is safe with no potential for abuse, Walley said. In fact, he added, “It’s the last thing somebody who is opioid tolerant wants because it takes away their high.”

But a mishmash of state laws governing dispensing of naloxone complicates the task of getting the drug to members of the community. As of early this year, the authors write, Walgreens offers naloxone without requiring a prescription in 40 states.

But every state has a unique set of requirements. Consistent laws about naloxone dispensing across the U.S. would help, Shafer said.

Other national pharmacy chains also have instituted programs to combat the opioid epidemic. Walgreens, however, is the only drugstore chain to install drug-disposal kiosks in some of its stores, Caruso said.

The U.S. Drug Enforcement Administration and local law enforcement agencies host regular prescription drug take-back events for safe disposal of prescriptions drugs. The DEA’s next National Take-Back Day will be on Saturday, April 29.

Pharmacies bear some responsibility for the overprescribing of opioids, Walley said.

“For some time now, opioid overdose has been recognized as a public health crisis. We didn’t get pharmacies involved soon enough, and we’re now playing catch-up,” said Walley, a professor at Boston Medical Center.

“Pharmacies are the most widely available health outlets in our communities. The fact that they are explicitly developing a strategy to implement public health measures to prevent overdose is a step,” he said.

Walley was not involved in the new report, but as a volunteer, he has written standing orders that allow Walgreens pharmacists in Massachusetts to dispense naloxone to opioid users who might need it.

U.S. pharmacists fill 650,000 opioid prescriptions every day, “a significant portion . . . due to inappropriate prescribing,” the authors write.

Since 1999, the number of U.S. opioid overdose deaths quadrupled, along with sales of the painkillers, according to the Centers for Disease Control and Prevention (CDC).

Every day, more than 1,000 Americans are treated in emergency rooms for opioid misuse, and 91 die from opioid overdoses, according to the CDC.

The CDC last year released guidelines urging primary-care physicians to dramatically curtail prescribing opioids for chronic pain. The guidelines recommend other, non-addictive medications, such as acetaminophen and ibuprofen, for chronic pain unless patients have cancer or are receiving palliative or end-of-life care.

The guidelines further suggest that when doctors do prescribe opioid painkillers, they prescribe the lowest possible dose and also prescribe physical therapy, exercise and other non-drug approaches to pain control.

SOURCE: Journal of the American Pharmacists Association, March-April 2017.