White House ONDCP strategy targets prescription drug abuse

Pharmacists can help prevent and treat substance abuse.

Framing illicit drug use as a public health threat and drug addiction as a preventable and treatable disease, the White House Office of National Drug Control Policy (ONDCP) has released the 2011 National Drug Control Strategy with three policy priorities: reducing prescription drug abuse, addressing drugged driving, and preventing drug use before it begins.

The 108-page drug strategy was released July 11. It is divided into seven areas, including two focused on health care—“seeking early intervention opportunities in health care” and “integrating treatment for substance use disorders into mainstream health care and expanding support for recovery.” The details of the prescription drug abuse policy align with a White House plan issued April 19, Epidemic: Responding to America’s Prescription Drug Abuse Crisis. Both the ONDCP drug strategy and the interagency epidemic plan use education, tracking and monitoring, proper medication disposal, and enforcement in their approach to prescription drug abuse, which both documents call the nation’s “fastest-growing drug problem.”

“The report is a comprehensive document that details the Obama administration’s strategy to combat the public health epidemic of drug use, with a focus on prescription drug abuse,” said Sarah T. Melton, PharmD, BCPP, CGP, FASCP, Director of Addiction Outreach and Associate Professor of Pharmacy Practice, Appalachian College of Pharmacy. “Every pharmacist should read the strategy and decide where they, as a health care professional, fit in to be agents of change in fighting the prescription drug abuse epidemic across the United States.”

Achievable goals
The drug strategy has twin goals for 2015 of curtailing illicit drug consumption and improving public health and safety by reducing the consequences of drug abuse. The first goal is to decrease the 30-day prevalence of drug use among 12- to 17-year-olds by 15% and among 18- to 25-year-olds by 10%, and to reduce the number of chronic drug users by 15%. The second goal is to reduce drug-induced deaths by 15%, drug-related morbidity by 15%, and the prevalence of drugged driving by 10%.

“Do I think these goals are achievable? Yes, if health, government, education, law enforcement, and the business and faith communities come together with the treatment and recovery communities to move us toward a culture of prevention, a recovery-oriented system of care, and other systems-based solutions,” Melton told pharmacist.com.

President Barack Obama’s proposed National Drug Control Budget for fiscal year (FY) 2012 requests $26.2 billion, 1.2% more than the FY 2010 enacted budget of $25.9 billion.

Role of pharmacists
“I have maintained that pharmacists can do so much more in the addiction disease space, including case finding, referral, medication counseling, and disease education,” said Anthony Tommasello, BSPharm, PhD, FAPhA, Lead Field Medical Advisor, Medical Department, Reckitt Benckiser Pharmaceuticals, and the author of a 2004 Harm Reduction Journal article, “Substance Abuse and Pharmacy Practice: What the Community Pharmacist Needs to Know about Drug Abuse and Dependence.”

According to Tommasello’s article, pharmacists need to understand substance abuse “at least as well as they understand other diseases.” Melton said that pharmacists must be educated in pharmacy school about addiction and continue to receive continuing education about chronic pain and addiction. Both substance abuse experts told pharmacist.com that pharmacists should be trained in SBIRT (Screening, Brief Intervention, Referral, and Treatment), a health care provider approach to substance abuse that’s emphasized in the ONDCP drug strategy. “I believe pharmacists are in a unique position to be able to do SBIRT in nearly all practice settings and this would make a very powerful impact with prescription and illicit drug abuse,” Melton said.

Pharmacists are front-line health care providers who can further engage in this issue. According to Melton, pharmacists must educate patients who receive opiates and identify those at risk for accidental overdose who are also prescribed other central nervous system–depressant agents. “We are the last people to see the patients before they take home medications that can result in inadvertent or deliberate overdose,” she said. “We, as a profession, have a responsibility to take on a key role in working collaboratively and closely with prescribers and law enforcement as a team to prevent and identify diversion.” Pharmacists need to use prescription drug monitoring programs, and be involved in drug take-back days, she said. Tommasello supports pharmacist recovery programs.

APhA activity
At the end of July, ONDCP held two invite-only pharmacy stakeholder meetings related to implementing the 2011 drug strategy. One meeting was about prescription drug abuse and the importance of education. There, ONDCP Director R. Gil Kerlikowske emphasized the importance of public health, not just law enforcement, in the strategy, according to Marcie Bough, PharmD, APhA Senior Director of Government Affairs. It was also highlighted in the meeting that the next DEA National Prescription Drug Take-Back Day is scheduled for October 29. Points of contact for each state are available on the DEA website. October is American Pharmacists Month and APhA will be working with DEA on comessaging.

The other ONDCP meeting attended by APhA was about pharmacy robberies, an area of increasing concern that ultimately ties into the drug strategy’s approach to drug-related crime.