Prescriber Education Is the Key to Stemming Prescription Opioid Abuse

The education of primary care providers and patients at the starting point of opioid therapy, as well as of surgeons and other prescribers, is crucial to curbing the current global opioid abuse epidemic, according to Adam M. Kaye, PharmD, FASCP, FCPhA, a professor in the Department of Pharmacy Practice at the University of the Pacific Thomas J. Long School of Pharmacy and Health Sciences.

Writing in Current Pain and Headache Reports, Kaye and colleagues said that technologies meant to make it more difficult to abuse opioids—developing pills that produce unpleasant side effects if broken, crushed, or injected—will likely have limited effectiveness in stemming the global epidemic of opioid abuse and are no substitute for education.

“Education is the foremost strategy,” Kaye said. “We must educate primary care providers, surgeons, pharmacists, and other health professionals, as well as patients. That education must take place prior to the starting point of opioid therapy—and it needs to be independent of the pharmaceutical industry.”

In the review article, the authors stated the following:

• Opioid misuse increased by 4,680% from 1996 to 2011.
• Opioids were involved in 28,647 deaths in 2014—three times as many as in 2000—and represented 61% of all drug overdose deaths.
• More than 90% of patients who survive a prescription opioid overdose continue to be prescribed opioids, usually by the same prescriber.
• Up to 80% of heroin users first took prescription opioids.
• The total cost of prescription opioid abuse in the United States has been estimated at $86 billion, including workplace, healthcare, and criminal justice expenditures

Kaye and colleagues discussed three drug formulations that have been developed to limit opioid abuse:

• Physical barriers, such as polyethylene oxide, which prevent accidental crushing or chewing.
• Sequestered aversive agents, such as niacin, which cause adverse events in patients who chew or crush tablets.
• Sequestered opioid antagonists, such as naloxone, which render the opioid ineffective

The authors wrote that although the first two may protect patients who do not intend to abuse opioids from an inadvertent overdose, neither is likely to deter an intentional opioid abuser. Sequestered opioid antagonists put addicted patients at risk for sudden withdrawal.

“Pharmacists have a big responsibility for cutting down opioid abuse and deaths, whether it's Prince or other celebrities—or the guy down the street,” said Kaye. “We have to be part of primary education efforts.”