Auburn Professor in Harrison School of Pharmacy offers answers concerning nation’s opioid crisis and recent legislation

Kimberly Braxton Lloyd, Auburn University’s assistant dean for Health Services, director of the Auburn University Pharmacy Health Services and a professor in the Harrison School of Pharmacy, offers the below answers concerning the nation’s opioid crisis and recent legislation signed into law by President Donald Trump.

1. How might this new legislation help in combating the nation’s opioid epidemic?
The new legislation provides approximately $8 billion in funding for research that is targeted at solving the opioid epidemic in the United States. One area of focus of this funding is for pharmaceutical companies to pursue non-addictive treatment alternatives for opioids. This would provide more options for the medical management of acute and chronic pain in patients that require relief. This is a very important step in ensuring that patients who have chronic pain associated with trauma, cancer or other disease will receive effective medications to manage their pain without the risk of addiction. The new legislation also facilitates the management of opioid use disorders by the utilization of telemedicine. This is a critical step in the management of opioid addiction in rural and medically underserved communities. 

2. Can you put into perspective just how large of a crisis opioid abuse is in this country?
In 2016, the U.S. Centers of Disease Control (CDC) declared opioid drug abuse an epidemic. Every day approximately 135 people die of an intentional or non-intentional opioid overdose in the United States. The highest rates of death are seen in the northeastern states. 

In Alabama, we see one of the highest prescribing rates of opioids in the nation. In 2013, we observed 141 opioid prescriptions for every 100 individuals, which was the highest rate in the country and almost twice as high as the U.S. average at that time. In 2015, this incidence decreased slightly to 120 opioid prescriptions per 100 individuals in our state, but this is still an issue that puts our citizens at risk of morbidity and mortality associated with opioid use.

3. How is Auburn helping address the topic?
Auburn University researchers are working to identify medications that might be abused in the future, so that we are aware of how current chemical compounds may be modified to increase potency, addiction potential and abuse. This allows law enforcement to be prepared for future opioid abuse trends.  

Auburn University researchers are also working on solutions to the fragmented prescription drug monitoring program (PDMP) data that are currently available to healthcare providers in the primary care and pharmacy environments to improve the databases that clinicians use on a daily basis. They are working to integrate these data with the electronic health and prescribing records so the process of checking a patient’s opioid utilization is more seamless and effective.

We are also working on integrating opioid overdose prediction algorithms into the prescribing and dispensing software programs so that prescribers and pharmacists are alerted when the potentially life-saving drug, naloxone, should be offered to the patient and family. Currently, the pharmacist receives no trigger or reminder that this may be indicated. 

Finally, Auburn researchers are working on developing, implementing and assessing innovative emergency response strategies. We are developing a model that utilizes health care students to increase outreach to college and university communities about the risk of opioid use, addiction and overdose; to increase the availability of naloxone on college campuses; to train and equip first responders with naloxone; and to increase access to medication destruction services which would remove unused medications from circulation in the community.  

4. What are challenges faced by pharmacists and physicians when dealing with opioid prescription drugs?
In the current climate, physicians and pharmacists must ensure that patients who are experiencing acute or chronic pain are appropriately assessed and treated with therapies, which include prescription medications, to control their symptoms.  At the same time, health care providers must be ever vigilant in identifying patients who are not candidates for opioid medications and avoid over-prescribing these medications when they are not indicated. This is very important in order to prevent the risk of addiction and abuse amongst patients and the possible diversion of these drugs.

5.  Are there further steps Congress could take that might help?
In order to avoid these possible negative outcomes, such as addiction, abuse and diversion, physicians and pharmacists must have access to timely and complete data concerning a patient’s utilization of opioid medications. This is currently obtained from a state-level prescription drug monitoring program (PDMP). The data reported to these PDMPs are not consistent and are not shared between all states, which gives the health care provider incomplete data when assessing a patient’s medication use patterns. The implementation of a federally mandated and managed PDMP would improve the healthcare provider’s ability to review all pertinent information before prescribing an opioid.

6. What signs should someone look for in determining if someone is an opioid abuser and in need of help?
Friends, family members and roommates should watch for signs and symptoms of opioid addiction if they suspect that someone in their life might have a problem.  People who suffer from drug addiction might have changes in their usual behavior, for instance:

• Social isolation (spending more time alone and not interacting with friends or family)
• Changes in hygiene (not showering, changing clothes, brushing teeth, etc.)
• Losing interest in normal activities
• Changes in mood (increased sadness, depression, anxiety, nervous, grumpy, mood swings, etc.)
• Decreased energy / increased tiredness / increased sleep / sleeping odd hours
• Changes in reliability (missing appointments, missing classes, missing payments, financial hardship, etc.)
• Eating more or less than usual, weight gain, weight loss, or weight fluctuation
• Being overly energetic, talking fast, seeming “hyper”, saying things that are confusing, etc.
• Hanging out with new people, changing friends, changing social circles, changing behavior, getting in trouble with the law.
• Withdrawal symptoms may include feeling cold, shivering, tremors, shaking, irritability, desperate.

7. What role can pharmacists play in the treatment of opioid abusers?
Pharmacists can help identify medication use patterns that might increase the risk of opioid addiction and intervene early in order to prevent this addiction from developing. Also, pharmacists can assist patients who are addicted in accessing outpatient and inpatient treatment as appropriate through referral to appropriate resources. 

Pharmacists in Alabama can also prescribe a potentially life-saving drug called naloxone, which can be administered by a friend or family member in the case of an opioid overdose. Pharmacists can prescribe and dispense this medication to patients who are at risk of an opioid overdose based on the patient’s prescribed medications, and train the patient and their family members on how to recognize the symptoms of an overdose and how to administer naloxone in the case of these potential emergencies.

Signs and symptoms of an overdose may include:

1. Person is passed out and non-responsive (shake, prod, shout and get no response)
2. Person has slow, shallow breathing (gurgling sounds)
3. Person has blue tinge to lips
4. Dilated pupils