Substance Use Disorders (SUDs) present a significant public health challenge, contributing to increased morbidity and mortality worldwide. In 2024, the World Health Organization reported over 3 million annual deaths due to alcohol and drug use. Traditionally, management of substance use disorders has been centered on physicians, addiction specialists, and behavioral health professionals. However, pharmacists are increasingly recognized as key players in the prevention, treatment, and recovery of individuals with SUDs. Their accessibility, expertise in pharmacotherapy, and frequent interactions with patients position them as valuable assets in the clinical management of these conditions.
Related: Clinical Management of Substance Use Disorders
Medication-Assisted Treatment (MAT) support
One of the most effective strategies for treating opioid and alcohol use disorders is Medication-Assisted Treatment (MAT). MAT combines FDA-approved medications with counseling and behavioral therapies. Pharmacists play a crucial role in:
- Dispensing and monitoring MAT medications such as buprenorphine, methadone, and naltrexone.
- Providing patient education on the proper use of these medications, potential side effects, and adherence strategies.
- Identifying potential drug interactions between MAT medications and other prescribed therapies.
Pharmacists who practice in states that allow collaborative practice agreements may even have the authority to adjust medication regimens in coordination with prescribers.
Comprehensive medication management
Pharmacists are increasingly involved in Comprehensive Medication Management (CMM) for patients with SUDs. This role encompasses evaluating medication regimens, ensuring the safe and effective use of medications, and monitoring for potential drug interactions. The U.S. Department of Veterans Affairs highlights the integration of Clinical Pharmacist Practitioners (CPPs) in providing CMM services within SUD treatment teams, emphasizing their contribution to improving patient outcomes.
Early intervention and screening
As some of the most accessible healthcare professionals, pharmacists can identify early signs of substance misuse and intervene before a disorder worsens. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a model that pharmacists can use as a tool for comprehensive care:
- Assess patients for risky substance use behaviors during routine medication reviews.
- Provide brief counseling and motivational interviewing to encourage behavior change.
- Refer patients to appropriate treatment services when necessary.
By integrating screening protocols into their practice, pharmacists can contribute to the early detection and management of substance use disorders, ultimately improving long-term patient outcomes.
Harm reduction strategies
Harm reduction is a public health approach aimed at minimizing the negative consequences associated with drug use. Pharmacists contribute to harm reduction through:
- Naloxone dispensing and education: Since naloxone can reverse opioid overdoses, pharmacists play a crucial role in ensuring access and training patients and caregivers on its administration.
- Safe syringe programs: In states where legal, pharmacists can provide clean syringes to prevent the spread of infectious diseases like HIV and hepatitis C.
- Counseling on overdose prevention: Educating individuals about safer drug use practices, recognizing overdose symptoms, and seeking timely medical intervention.
More on naloxone: Reducing opioid overdose mortality
The following information is from a CDC Fact Sheet published in 2024 targeted at pharmacists. Pharmacists play a critical role in mitigating the risks associated with opioid use by educating patients, caregivers, and the broader community on the importance of naloxone. Pharmacy expertise can help increase awareness of:
- The three available forms of naloxone (nasal spray, injection, and auto-injection)
- Proper administration techniques
- Recognizing the signs of an opioid overdose and responding effectively
Disparities in naloxone dispensing
Despite its life-saving potential, naloxone remains underutilized in certain populations:
- In 2018, rural counties had the lowest naloxone dispensing rates and were nearly three times more likely to have low-dispensing rates compared to metropolitan areas.
- Primary care providers prescribed only 1.5 naloxone prescriptions per 100 high-dose opioid prescriptions, despite these patients being at elevated overdose risk.
- More than half of naloxone prescriptions required a copay, potentially limiting access for high-risk individuals.
Currently, all 50 states, the District of Columbia, and Puerto Rico permit pharmacists to dispense naloxone without a prescription. However, pharmacists can further support public health efforts by proactively identifying at-risk patients and offering naloxone counseling.
Identifying patients at higher risk of opioid overdose
While anyone prescribed opioids is at risk for overdose, certain factors significantly elevate that risk, including:
- Previous history of opioid overdose
- Sleep-disordered breathing (e.g., sleep apnea)
- Concurrent benzodiazepine and opioid use
- Recent dose reductions or loss of tolerance (e.g., patients undergoing opioid tapering or recently released from incarceration)
- Higher opioid dosages (≥50 morphine milligram equivalents per day)
- Personal history of substance use disorder
Expanding access through pharmacist-community collaboration
Pharmacists are uniquely positioned to partner with local health departments and healthcare systems to improve naloxone access and education. These efforts can include:
- Encouraging patients and caregivers to request naloxone
- Advocating for insurance coverage and cost reduction strategies
- Providing educational outreach to high-risk individuals and their communities
- Enhancing harm reduction strategies by ensuring naloxone availability where overdoses are most likely to occur
By leveraging these strategies, pharmacists can play an integral role in reducing opioid-related mortality and supporting community-wide overdose prevention initiatives.
Education and counseling
Pharmacists serve as accessible sources of information for patients and their families. They provide education on the risks associated with substance use, safe medication practices, and the importance of adherence to prescribed therapies. Additionally, pharmacists counsel patients on harm reduction strategies and the availability of support resources, empowering them to make informed decisions about their health.
Collaboration with healthcare teams
Effective management of substance use disorders requires a multidisciplinary approach. Pharmacists collaborate with physicians, addiction specialists, social workers, and public health officials to:
- Develop comprehensive care plans that integrate pharmacologic and behavioral interventions.
- Advocate for policies that expand access to SUD treatments and harm reduction services.
- Participate in public health initiatives aimed at reducing stigma and increasing awareness about SUD treatments.
Pharmacists play a pivotal role in managing SUDs by supporting MAT, implementing harm reduction strategies, providing early intervention, and collaborating with healthcare teams. By leveraging their expertise and accessibility, pharmacists can significantly contribute to reducing the burden of substance use disorders and improving public health outcomes.
Barriers to integration
Despite the recognized benefits, several barriers hinder the full integration of pharmacists into management of substance use disorders:
- Scope of practice limitations: In some regions, regulatory constraints limit pharmacists’ ability to prescribe or modify SUD-related medications.
- Reimbursement issues: Lack of reimbursement models for pharmacist-led services can deter the provision of comprehensive care.
- Stigma: Both patients and healthcare providers may harbor stigmatizing attitudes toward SUDs, affecting the utilization of pharmacist-led services.
Opportunities for enhancement
Addressing these challenges presents opportunities to enhance pharmacists’ roles in SUD management:
- Policy reform: Advocating for expanded scopes of practice and reimbursement structures that recognize pharmacists as essential providers in SUD care.
- Education and training: Implementing specialized training programs to equip pharmacists with the skills necessary for SUD management.
- Public awareness campaigns: Reducing stigma through education and promoting the pharmacist’s role in SUD prevention and treatment.
