Pharmacists are caught in the throes of a relentless overdose crisis that has already claimed half a million lives and threatens to claim thousands more. The addiction treatment system is fragmented and inadequate to meet demand. Few physicians provide medications for opioid use disorder (MOUDs), the most effective forms of evidence-based treatment, and insufficient treatment options leave patients vulnerable to overdose.

Pharmacists routinely interact with patients who have opioid use disorders, but lack ways to treat them. The primary tools that pharmacists have received to curb the crisis are prescription drug monitoring programs (PDMPs), big data surveillance technologies that pharmacists can use to track patients’ drug acquisition patterns. Pharmacists like PDMPs because they help them make decisions efficiently. However, PDMPs are enforcement technologies, not healthcare tools, so pharmacists typically use PDMPs to police patients instead of treat them. Policing patients not only fails to help combat overdose, but can also exacerbate harm.

Informed by a decade’s worth of interviews with pharmacists before and after PDMP implementation, I argue that pharmacists should be better equipped to help patients with opioid use disorders. Specifically, clinical and community pharmacists should mobilize to provide MOUDs through collaborative practice agreements with physicians. Studies show that collaborative practice models are effective at reducing the risk of overdose and saving money and physicians’ time. And pharmacists have the clinical competencies necessary to provide MOUDs for patients. Pharmacists must overcome legal, economic, and interprofessional barriers to do so, but giving pharmacists the tools to treat patients will affirm their professional commitment to caring for patients and saving lives.

Accepted: June 18, 2021

Received in revised form: June 18, 2021

Received: March 9, 2021

CRediT

Elizabeth Chiarello was responsible for all roles in this paper.

Funding

This research is supported by a National Science Foundation CAREER Award co-sponsored by the Sociology and Law and Science Programs. Award #1753308. Award Dates: 2018-2023.

COI The author declares no relevant conflicts of interest or financial relationships.

Key points

What was already known:

• The overdose crisis has claimed over half a million lives and overdose rates are skyrocketing during the pandemic, yet addiction treatment options are inadequate.

• Pharmacists are caught in the throes of the overdose crisis and find themselves responsible for deciding who receives access to opioids.

• Key tools that pharmacists use to address the overdose crisis are prescription drug monitoring programs (PDMPs) that track patients’ drug acquisition patterns.

What this study adds:

• PDMPs are enforcement technologies, not healthcare tools. Pharmacists who use them without healthcare resources tend to police patients instead of treat them.

• Pharmacists have an opportunity to expand access to addiction treatment by providing medications for opioid use disorder (MOUDs) through collaborative practice agreements with physicians.

• Pharmacists have the clinical capacity and the workforce necessary to provide addiction treatment and save lives.

DOI: https://doi.org/10.1016/j.japh.2021.06.019

© 2021 Published by Elsevier Inc. on behalf of the American Pharmacists Association.