The MCW School of Pharmacy's 4th Annual Symposium focused on opioid addiction
The U.S. Department of Health and Human Services estimates that nearly 4000 new people in the United States start abusing prescription opioids every day. The MCW School of Pharmacy’s 4th Annual Symposium, held on July 11, 2019, was held to raise awareness of this issue and to address challenging and innovative topics concerning the opioid crisis. The symposium, “Strengthening the Response: Perspectives on the Opioid Crisis,” was attended by approximately 200 students, residents, clinicians and faculty.
The symposium serves as a springboard for the first-year pharmacy MCW students who began their classes earlier that week. The students will encounter topics on opioid abuse and addiction often throughout their education and eventually as pharmacists.
“The pharmacy symposium was educational on what is happening in the greater Milwaukee area in terms of the opioid epidemic that is facing healthcare and the challenges that are associated with it,” says Jackson Straughan, a first-year MCW pharmacy student. “I think it brought an insight as how we as future pharmacists can play a role in negating the ripples of opiate abuse and disorders.”
Opioids are substances that interact with one of three specific types of receptors in the brain. “These receptors are mainly involved with pain, which is why opioids help to reduce the pain sensation and are prescribed as analgesics. But in addition to the effect on pain, they also have other effects, like increasing the feeling of reward, which is why patients get addicted to these drugs” says Abir El-Alfy, PhD, MS, Associate Professor in the Department of Biopharmaceutical Sciences at the MCW School of Pharmacy. Opioid addiction is a complex brain disorder involving both genetic and environmental factors.
Opioid abuse and addiction are not just nationwide issues, but ones that have significantly affected the MCW’s local community. Last year in Milwaukee County, there were 208 opioid related deaths and 1401 Emergency Medical Service (EMS) calls where naloxone, an opioid overdose reversal drug, was used on the scene, according to the Milwaukee Community Opioid Prevention Effort. However, about 80% of naloxone users don’t call EMS afterward, indicating that the number of opioid overdoses in Milwaukee County is likely much higher. “People are still wary of law enforcement and physicians,” says Jillian Theobald, MD, PhD, Assistant Professor in the Department of Emergency Medicine at the Medical College of Wisconsin. “This speaks to the comfort level of people coming in to see us as providers, and also the system as a whole.” Both of these statistics show the importance of training pharmacists to provide care to patients who are addicted to opioids, especially in rural or underserved areas where pharmacists are more accessible.
There are many innovative ways in which pharmacists can get involved on the public health side of the opioid epidemic. “Wisconsin has really become a model nationwide in legislation that created opportunities for pharmacists to get involved in ways that previously either weren’t allowed in state law or just hadn’t been thought about,” says Danielle Womack, MPH, Vice President of Public Affairs at the Pharmacy Society of Wisconsin. One main way in which pharmacists can help is through their ability to dispense naloxone on-site at a pharmacy by using the statewide standing prescription order signed by the Department of Health Services Chief Medical Officer. They are able to dispense naloxone to people without prescriptions who are at risk of an opioid overdose or to someone who is in a position to assist someone at risk for an overdose.
Pharmacists in Wisconsin are also able to use the Prescription Drug Monitoring Program to look for trends that point to opioid abuse in their patients. Pharmacists can work on harm reduction of some of the side effects of opioid addiction, such as HIV and Hepatitis C, by providing a needle exchange, dispensing pre-exposure prophylaxis (PrEP), and providing point-of-care rapid HIV tests. Pharmacists can try to reduce the number of opioids that are obtained by non-medical users by encouraging safe disposal of opioids through methods such as using medication drop-off bins or products like DisposeRx.
Pharmacists in the emergency room can help patients who are dependent on opioids through Medication Assisted Treatment (MAT) such as Buprenorphine, Naltrexone, and Methadone, which reduces mortality associated with opioid overdose. “There are many aspects of MAT that pharmacists can get involved in. It can be helping patients get referred for MAT clinics or it could be involvement with the dosing around induction of MAT with opioid use disorder,” says Matthew Stanton, PharmD, BCPS, DABAT, Clinical Assistant Professor in the Department of Clinical Sciences at the MCW School of Pharmacy.
Recent U.S. government data shows that the number of drug overdose deaths have dropped by about five percent from last year, showing that efforts such as naloxone standing orders and increasing access to MAT may be already be working. However, the opioid epidemic is still far from over.
“We’re in place where we need to be continually learning. We need to be engaging and fostering a world of collaboration, whether it’s with our patients or other professionals, as well as coming up with innovative ways to solve some of these problems,” says Dr. Stanton. “I think there are pharmacist opportunities out there. Really think outside of the box. If you’re not sure what to do yet for the rest of your careers, this could be a pathway to consider.”
The MCW School of Pharmacy offers a variety of professional development programs. “Continuing education programs such as Strengthening the Response: Perspectives on the Opioid Crisis educate not only the pharmacists of the future but help prepare pharmacists to address new issues and gain skills relevant to the expanding roles and responsibilities of the profession,” says Karen MacKinnon, Director of Outreach Programs and Assistant Professor of Clinical Sciences at the MCW School of Pharmacy.