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Nicole Perea: As Washington state moves to address the opioid crisis, prescribers must lead locally

Nicole Perea

As Washington state moves to address the opioid crisis, prescribers must lead locally

Twelve years ago, one of my best friends harmlessly tried opiates for the first time. Two years later, he tried heroin for the first time. Fast-forward to today, and he has been clean for six years. Unfortunately, this story isn’t unique, and it doesn’t always end with recovery. Seeing how opiates can negatively impact a person’s life, and how that touches so many lives around them, motivated me to try to minimize this epidemic as a pharmacist, which is why I am pleased to see Washington implement a new law to co-prescribe naloxone to prevent accidental overdoses.

The statistics are alarming. The best available data suggests 83 percent of prescription opioid deaths are accidental[1] – a preventable outcome, assuming patients better understand the seriousness inherent to their prescription and providers have the tools to better educate and prepare them.

Alarmed by the rise in opioid overdose deaths in Washington over the past several years, the state Legislature passed, and the governor signed into law, new requirements for prescribing, monitoring the use of, and treating opioid use disorders.

Beginning Jan. 1 of this year, any medical professional prescribing opioids is supposed to engage and assess their patients on these therapies. The new law’s prescribing guidelines are intended to reduce the number of people who inadvertently become addicted to opioids and decrease accidental overdoses from these medications. To accomplish this, health care providers are directed to co-prescribe naloxone, the opioid overdose antidote, to patients who may be at risk of overdose, and to make naloxone more widely available to others as well.

Efforts to reduce these deaths are not an indictment of appropriateness of prescribing or using opioids for pain management. It is important for patients to have access to appropriate and effective pain relief tools. However, we should also understand the serious potential risks when dealing with powerful therapies.

A car is also a useful tool. But operating a motorized vehicle carries risks that we, as a society, have recognized and responded to. We don’t think twice about requiring seat belts, bumpers, and airbags in cars. Similarly, we shouldn’t think twice about co-prescribing naloxone to an opioid patient.

The National Institutes of Health has demonstrated that patients who received a prescription for naloxone alongside long-term opioids had 47 percent fewer opioid-related emergency department visits after six months and 63 percent fewer visits after one year, compared with patients who did not receive naloxone[2]. In 2016, I worked with a talented team of researchers at the University of New Mexico Pain Clinic who adopted naloxone co-prescription as a universal precaution for opioid patients based on similar findings[3]. In part, the study posits that the effectiveness of the co-prescription could be rooted in the educational conversation between a doctor and a patient about their prescription. As a licensed pharmacist, I can tell you this conversation isn’t always comfortable – but I, personally, take the time to explain and answer tough questions, because patients who are better informed are far less likely to accidentally overdose.

Unfortunately, a great deal of stigma still surrounds the use of naloxone because of its presumed affiliation with opioid use disorder. But the application, training and use of an intervention like naloxone is a universal precaution that improves health outcomes at the community level – much like CPR training. Providers should lead the way on educating patients and the public about naloxone.

The opioid crisis is something that we have to grapple with at a societal level – no single agency or group of professionals is responsible for creating a healthier, more well-informed public. By working together, sharing information, and being more conscious about the application and use of evidence-based interventions like naloxone, we may be able to stem the tide of the crisis and create a healthier future for all Washington families.

Nicole Perea is a pharmacist based in Spokane, completing an academic fellowship at Washington State University College of Pharmacy and Pharmaceutical Sciences and working at Walmart Pharmacy.

[1] Pain Physician, May 2016

[2] Annals of Internal Medicine, August 2016

[3] Substance Abuse Journal, April 2016