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. 2024 Oct 22;14(9):519–529. doi: 10.1080/17581869.2024.2411930

Combatting opioid misuse, overuse and abuse: a systematic review of pharmacists' services and outcomes

Bhuvan KC a,*, Alian A Alrasheedy b, Mohamed Izham Mohamed Ibrahim c, Vibhu Paudyal d,e, Christina Malini Christopher f, Sunil Shrestha g, Shakti Shrestha h
PMCID: PMC11728331  PMID: 39439259

Abstract

Aim: To examine the range of services pharmacists provide and their impact on patient outcomes, harm reduction, and appropriate opioid use.

Methods: Six databases were searched (MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL and Cochrane Methodology Register) from inception to March 2023. The protocol was registered in PROSPERO (CRD42023401895).

Results: Twenty-nine studies identified five key areas of pharmacist interventions in opioid management—naloxone programs and opioid de-escalation, patient and primary healthcare providers' education and motivational interview, prescription monitoring and opioid risk screening, clinical pharmacy interventions (pharmacotherapy, medication review, prescribing, adherence monitoring), and collaborative healthcare approaches to promote optimal opioid use. Outcomes assessment indicated harm reduction, improved safety, increased non-opioid analgesic use, decreased opioid consumption, and enhanced pain management.

Conclusion: This review underscores pharmacists' vital role in tackling opioid misuse, overuse and abuse, providing a foundation for evidence-based policies to minimize harm and promote optimal opioid use.

Keywords: : clinical interventions, harm reduction, opioids, pharmacists' services, themes

Plain Language Summary

What is this summary about?

This study investigated the scope of services provided by pharmacists and their impact on patient outcomes, harm reduction, and appropriate opioid utilization.

What were the results?

This review identified five key areas of contributions made by pharmacists in rational opioid prescribing and use and demonstrated a positive impact on core outcomes.

What do the results mean?

These results emphasize the critical role of pharmacists in addressing the complex issues surrounding opioid use, misuse and abuse.

Plain language summary

Article highlights.

  • Pharmacists' services significantly reduce opioid-related harm, including through naloxone programs and opioid de-escalation.

  • Educational interventions by pharmacists improve patient adherence and knowledge regarding opioid safety.

  • Collaborative care approaches between pharmacists and other healthcare professionals enhance patient outcomes and reduce opioid misuse.

  • There is a critical gap in addressing misuse of other opioid substances beyond naloxone.

1. Introduction

Opioids are commonly prescribed as a potent analgesic for the management of persistent or severe pain, including non-cancer pain but not limited to acute pain, post-surgical recovery, palliative care, and cancer pain management [1,2]. The benefit of opioids in pain management is often undermined by the harm associated with their use, such as physical dependence, respiratory depression, tolerance, constipation, vomiting, dizziness and nausea, with some potentially leading to fatal toxicity and death [3].

Opioids were underutilized for pain management, particularly in the United States (US) and Northern Europe [4,5], until the late 1990s when the focus and initiatives increased and lead to a surge in the prescription of opioids. However, there was a corresponding increase in the illicit opioid use leading to the opioid epidemic [6]. This epidemic significantly increased global drug-related deaths and had profound economic, public health and societal impacts [6–9]. In the early 2000s, global prescription opioid use for non-cancer pain treatment increased [10–13]. Between 2015 and 2019, opioid consumption continued to rise in 66 other countries despite effective interventions in the US to slow this trend [13]. The multifaceted issues surrounding opioid use influenced the clinical, public health and societal dimensions; with the non-medical use including misuse and abuse carrying significant economic implications. In 2021, 60 million people globally used opioids, with 39.5 million living with opioid use disorder [14], highlighting the seriousness of premature opioid-related deaths [15]. Countries and health systems have implemented policies, programs and measures to address the crisis for non-medical use [16]. Various interventions, including pharmacological interventions, behavioral and psychosocial interventions, rehabilitation, recovery and reintegration, and harm reduction services, are employed to combat the crisis [17].

Pharmacists play a crucial role in opioid stewardship, monitoring, patient education and regulatory affairs within the health system framework [18–22]. For instance, through prescription drug monitoring programs (PDMPs), pharmacists manage controlled substance use and identify inappropriate opioid use patterns [23]. PDMP is an intervention which is used to manage and reduce harms associated with high-risk prescription medicines [24]. PDMP is currently being conducted in developed countries such as the USA, Canada, Australia, and a few European countries [25]. Pharmacist involvement aims to promote safe opioid use, minimize addiction risk, and collaborate with healthcare professionals to implement evidence-based guidelines [26–29]. Studies emphasize the role of pharmacists in regulating opioid use at hospital and community levels via opioid stewardship, monitoring opioids for problematic use and prescription, educating patients, and regulating its usage provisions and control [18–21,29]. However, the comprehensive scope of pharmacists' contributions remain unexplored. Therefore, this systematic review examines pharmacists' diverse services in addressing opioid misuse, abuse and overuse, and their public health implications.

2. Methods

2.1. Study design

The study protocol of this systematic review was registered in PROSPERO CRD42023401895. The study was conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement [30].

2.2. Eligibility criteria

This systematic review focused on studying the population of patients who use opioids and experience issues related to opioid misuse, abuse and overuse. The intervention of interest was pharmacist services targeting opioid misuse, overuse and abuse. As the emphasis was on evaluating the outcomes of the pharmacist-led interventions, no comparison group was used. Due to limited resources, this systematic review only considered original articles published in English, as translator services were not available. The selection criteria were based on the population, intervention, comparator and outcomes (PICO) framework as shown in Table 1.

Table 1.

PICO criteria for inclusion of studies.

Parameter Inclusion
Population Patients using opioids and experiencing opioid misuse, abuse and overuse
Intervention Pharmacists' services for opioid misuse, overuse and abuse
Comparison Not applicable (no comparison groups)
Outcome Assessment of the services provided by pharmacists for addressing opioid misuse, overuse and abuse
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2.3. Study selection

The electronic search was performed in six databases from inception until March 2023: MEDLINE, EMBASE, Scopus, APA PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Methodology Register. Grey literature and Google Scholar were checked for additional studies. The detailed search strategy in different electronic databases is in Appendix 1. Two authors (BKC and CMC) screened the titles and abstracts, and a third author (SuS) verified them.

2.4. Data extraction

For data extraction, a custom-designed form in MS Excel Version 365 was employed, encompassing various aspects such as study design, demographics, setting, interventions, sample size, follow-up period and main findings. Two authors (CMC and BKC) independently conducted the data extraction, ensuring thoroughness and accuracy. Any discrepancies or disagreements between the two authors were resolved through consultation with two other authors (AAA and ShS). Meta-analysis was not performed due to significant heterogeneity observed in methods and study designs across the reviewed literature.

2.5. Outcomes

Primary outcomes were (i) nature of services provided by the pharmacists for opioid misuse, overuse and abuse irrespective of settings, and (ii) outcomes of pharmacists provided services such as reducing the risk of opioid-related harm, reduction in the number of opioid prescriptions, number of treatment retention and opioid abuse.

2.6. Risk of bias

Two independent reviewers (CMC and SuS) assessed the risk of bias in the included studies. Joanna Briggs Institute (JBI) Critical Appraisal Checklists was employed to evaluate the risk of bias in the included studies, specifically for cross-sectional, randomized controlled trials (RCTs), quasi-experimental and cohort studies [31]. Any disagreements between the review authors over the risk of bias in the included studies were resolved by discussion with a third author (BKC). The risk of bias for individual studies was determined using the following thresholds: a low risk of bias if 70% of the answers scored yes, a moderate risk if 50 to 69% of the questions scored yes and a high risk of bias if the yes scores were below 50% [32].

2.7. Data analysis

A narrative synthesis was performed to consolidate the findings from the included studies. Each study was assessed based on the settings, the specific types of opioid services delivered by pharmacists and the outcomes of these services.

3. Results

3.1. Characteristics of included studies

A total of 12,390 articles were initially identified for this systematic review. After excluding 11,973 studies and removing 143 duplicates, 274 studies underwent a full-text review. Ultimately, 29 studies were included and analyzed. The reasons for excluding full texts and the study flow are depicted in Figure 1. Supplementary Table S1 presents the distribution of studies across various settings, with twelve conducted in tertiary settings [33–43], nine in community pharmacies [44–52], five in primary healthcare settings [53–57], one in a public health department [58] and one in suburban health departments [59]. Among the included studies, ten were quasi-experimental study designs [33,35,37,41,43,49,51–53,59], ten were cohort studies [34,36,38,46,55–58,60,61], five were RCTs [39,40,44,47,54] and four were cross-sectional studies [42,48,50,62]. The majority of the studies were conducted in the United States (n = 23) [33,34,36,38,39,42–46,49–57,59–61] followed by Australia (n = 3) [35,41,48], United Kingdom (n = 1) [47], France (n = 1) [37] and Canada (n = 1) [58].

Figure 1.

Figure 1.

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PRISMA flowchart.

3.2. Risk of bias

All the cross-sectional studies included in this systematic review were found to have a low risk of bias [43,48,50,62]. Cohort studies (9/10) in this review had a low risk of bias [34,36,38,42,56–58,60,61], while one study had a moderate risk of bias [55]. Among the ten quasi-experimental studies, five had a moderate risk of bias [33,35,46,49,59] and the remaining five had a low risk of bias [37,41,51–53]. Four of the five RCTs had a low risk of bias [39,40,47,54], while one trial had a medium risk [44]. Supplementary Table S2 provides an overview of the critical appraisal conducted on the included studies.

3.3. Pharmacy managed opioid services & their outcomes

The current systematic review identified several pharmacy-based opioid services, their outcomes and potential limitations, which are described and summarised in Supplementary Table S3.

3.4. Naloxone program & opioid de-escalation

This theme defines naloxone service as the primary intervention, with naloxone dispensing and kits implemented at the pharmacy level to reduce opioid overdose fatalities. Several studies were identified in the literature that addressed the naloxone program and opioid de-escalation by pharmacists. Under this theme, only one RCT were utilized to provide evidence on pharmacist involvement [54]. Other included studies were mostly cross sectional and cohort designs which reduced the quality and level of evidence [35,48,50,58,61]. However, based on the quality of studies, only one had moderate risk of bias and therefore because of high quality of most included studies, it has escalated the quality of the current theme [35]. Four studies identified naloxone service as the primary intervention in which pharmacists employed naloxone rescue kits or educational strategies to reduce opioid-related harm and overdose fatalities [50,54,58,61]. Two studies investigated the effect of naloxone dispensing kits on individuals at high risk of opioid overdosing [54,58]. These studies have reported reduction in opioid-related harm and overdosing risk but with significant increase of naloxone utilization. It provides the reversal action of opioid overdose. For example, Bui et al. [35] studied pharmacists' involvement in prescription monitoring and pharmacist-led opioid de-escalation service, respectively, which reported reduced opioid use, decreased adverse effects and improved pain management. In addition, these studies showed that the involvement of pharmacists helped in reducing opioid-related harm and fatalities via naloxone dispensing and led to good uptake of naloxone. Besides, it also showed that pharmacists' involvement in patient education, prescription monitoring and opioid de-escalation helped in increasing non-opioid analgesic use, decreasing opioid use and improving pain management [35,54,61]. These interventions related to the naloxone program and opioid de-escalation were carried out in primary care and tertiary care settings in the US (n = 4), Canada (n = 1) and Australia (n = 1).

3.5. Patient & primary healthcare providers' education & motivational interview

This theme provided a definition on patient education as a service focusing on opiate dependency and overdose. Several studies were identified in the literature that involved pharmacists educating patients and healthcare providers [33,39,43,47,53,60]. Under this theme, two studies were conducted via RCTs [39,47]. Among the studies within this theme, only one exhibited a moderate risk of bias. However, the overall quality of evidence across the studies remains high. Of these, three studies focused on patient education regarding opioid dependency and overdose [33,39,60]. These studies reported on providing services involving patients with a one-page information sheet on hydrocodone-acetaminophen, both presented in written form and read aloud by a nonblinded research assistant. Follow-up phone calls were conducted 4–7 days after the visit to assess the patient's comprehension of the medication and self-reported adherence to safety-related practices [39]. Also, in a study by Hoefling et al., an informative letter was sent outlining the purpose of rescue kits and offering instructions on obtaining one [60]. The education-based intervention was associated with a reduction in total daily morphine milligram equivalents (MME) and an increased use of non-opioid analgesics. In addition, Ball et al. [53] conducted a study on academic detailing outreach intervention within prescription drug monitoring programs (PDMPs) and reported an increase in PDMP system utilization following the academic detailing intervention. In three studies, education was provided to primary healthcare providers to implement strategies to promote appropriate opioid dosing and mitigate the risk of overdose [33,43,53]. These educational sessions aimed to familiarize prescribers with multimodal acute pain management principles, emphasizing the utilization of non-opioid analgesics and complementary pain management strategies. One study employed motivational interviewing as a method to promote opioid safety and enhance communication among opioid-dependent patients [47]. Brief motivational interventions were conducted by professionals trained in basic motivational interviewing skills [47]. The intervention has resulted in improved communication and increased treatment satisfaction. Overall, these services contributed to optimal opioid use by effectively educating both patients and healthcare providers on this aspect of healthcare.

3.6. Prescription monitoring & opioid risk screening

This theme provides an interpretation that opioid risk screening programs were the main initiatives to improve patient safety related to harm reduction. This theme focuses on screening as the primary intervention to enhance patient safety, whereas the previous theme centered on enabler strategies contributed by healthcare providers. This theme includes one RCT and two cohort studies [34,45,46]. While the risk of bias of one study seems to be of low risk, the other two were exhibiting medium risk. Two studies discussed opioid risk screening programs aimed at enhancing patient safety through harm reduction [45,46]. In these programs, pharmacists assessed the risks associated with opioid use and addressed related concerns while educating patients on the safe use of opioids. This included discussing potential risks, adverse effects, proper storage practices and appropriate medication disposal methods. In one of the studies, Boren et al. [34] reported improved patient adherence and reduced opioid-related harm. Another study focused explicitly on involving clinical pharmacists in pain and opioid practice management by implementing a Prescription Monitoring Program (PMR) [34]. This service provides electronic database that tracks controlled substance prescriptions. The introduction of this service resulted in a reduction in Morphine Equivalent Dose (MED), improved medication adherence and led to optimisation of both opioid and non-opioid medications.

3.7. Clinical pharmacy interventions (pharmacotherapy, medication review, prescribing & adherence monitoring)

This theme defines as main clinical interventions with pharmacist being involved actively. Several studies were identified describing and reporting pharmacist medication review services outcomes in promoting quality opioids use [37,41,44,49,55]. In terms of study design, one was an RCT, three quasi experimental and two cohort studies were reported under this theme [37,38,44,49,55,56,63]. Two non-randomized studies showed medium risk of bias [49,55]. Three studies highlight medication use management as services provided to individuals dependent on opioids [38,41,44]. Pharmacists conducted comprehensive assessments of patients' medication histories, evaluated the appropriateness of prescribed medications and provided recommendations to prescribing physicians to improve medication management [41]. Cochran et al. [44] implemented a pharmacist-driven program, combining education, motivational interviewing and monitoring to enhance patient outcomes for individuals with opioid use disorders in outpatient settings. Two other studies focused on pharmacy-directed pain management services (PPMS) within opioid stewardship studies [49,56]. These interventions were utilized for consulting patients and functions in opioid stewardship studies. Poirier et al. [56] described a pharmacist-led service collaborating with healthcare team to optimize pain management. This included medication optimisation, pain monitoring and adverse events surveillance and patient education on pain management and opioid safety. Similarly, Manzur et al. [49] reported opioid management programs in a community pharmacy, emphasizing a comprehensive patient medication history evaluation and risk assessment. This program enhanced pharmacists' role ability to make clinically appropriate and safe decisions regarding the opioid dispensing. Another study demonstrated a personalised pharmaceutical plan focused on patients' perception and knowledge of their disease and medication. This involved educating patients on administration procedures and side effects and providing evidence of the clinical pharmacist's role in managing non-cancer pain with potent opioids [37]. This theme contributed toward and provided evidence of the roles of pharmacists in the optimal use of opioids.

3.8. Collaborative healthcare approaches to promote optimal opioid use

This theme shows the leveraging efforts between the integration of healthcare providers. Seven studies examined collaborative practices with other healthcare providers as the primary service to optimize opioid use effectively [36,40,42,51,52,57,59]. Out of these studies, only one was in RCT study design [40]. Also, as for the quality of studies, only one had a moderate risk of bias [59], and the rest had a low risk of bias [36,42,51,52,57]. The studies had provided evidence on providing collaborative approaches to promote optimal opioid use. For instance, Lagisetty et al. [36] provided recommendations to physicians on transitioning to non-opioid medications that were acceptable and feasible at appropriate levels. Similarly, an intervention aimed at optimizing buprenorphine use was implemented [59]. Furthermore, Electronic Medication Complete Communication was utilized to promote safe opioid prescribing by involving pharmacists in the emergency department team [40]. This approach not only improved patients' knowledge of opioid use but also facilitated their transition to safer medication options. Pharmacists' integration into the pain team proved to be an effective, leading to reduced high-risk opioid prescribing practices and a decrease in opioid-related adverse events [57].

Additionally, a study from the US showed that successful collaboration between pharmacists and physicians could improve induction rates onto buprenorphine and enhance treatment retention rates [51]. Moreover, collaboration between community pharmacists and physicians for methadone maintenance treatments demonstrated effectiveness and positive patient reception [52]. This intervention played a significant role in observing a notable decrease in opioid utilization among patients with chronic pain and a reduction in high-risk opioid prescription patterns and opioid-related adverse events. Overall, proper collaboration between pharmacists and physician provides an opportunity to enhance the optimal use of opioids in the communities.

4. Discussion

This systematic review explores pharmacists' roles in addressing opioid misuse, abuse and overuse, highlighting their positive contributions for harm reduction and appropriate opioid utilization. Although primarily focused on high-income countries, especially the US, this systematic review shows diverse pharmacist-led services such as naloxone programs, opioid education, risk screening, medication management and collaborative efforts with other healthcare professionals. Despite the positive outcomes observed, there is a clear need to restructure opioid related harm reduction services. This restructuring should focus on improving patient outcomes and reducing the risk of opioid-related harm, and it should involve pharmacists to ensure sustainability. Structured training, resources and organisational support are essential for pharmacists to play a more active role in combating the opioid crisis [64]. Integrating pharmacists' services into interdisciplinary approaches that consider social determinants of health, stigma elimination and legislative advocacy is crucial for effective intervention [65].

Additionally, while most interventions focus on naloxone, it is important to address the misuse and abuse of other opioid-related substances such as oxycodone, morphine and fentanyl, which are also linked to significant misuse. Recent studies have highlighted these substances as critical areas of concern [66–68]. A systematic review by Gustaffson et al. reports that fentanyl, morphine and oxycodone are frequently linked to preventable ADRs, medication errors and abuse, highlighting the need for taking actions to address strong preventable errors [69]. This gap highlights the need for harm reduction strategies that go beyond naloxone to address a wider range of opioids, ensuring a more comprehensive approach to managing opioid misuse. Pharmacist, via their public health and clinical services, play a crucial role in minimizing opioid misuse by contributing to these broader strategies.

Naloxone programs and opioid de-escalation interventions emerged as pivotal components, demonstrating promising results in reducing harm and improving patient outcomes [50,54,58,61]. Furthermore, pharmacist involvement in prescription monitoring and opioid de-escalation improved patient adherence, reduced opioid-related harm and improved pain management [34,35]. These findings suggested that incorporating naloxone programs and opioid de-escalation interventions into pharmacist-led services could significantly reduce opioid-related harm and improve patient outcomes. The findings of this systematic review align with the findings from previous research and support the growing body of evidence on the effectiveness of pharmacist-led interventions in addressing opioid-related harms [70–73]. However, there is a need to enhance naloxone access, educate on administration and use and promote evidence-based practices to prevent and manage opioid overdose [74].

Moreover, a significant number of opioid misuse cases are linked to medication errors, particularly in home settings [75], where patients may miscalculate doses. Fentanyl, due to its potency and the potential for errors, has been implicated in numerous adverse events [76,77]. Pharmacist-led interventions that focus on prescription monitoring and patient education are crucial in reducing such errors and ensuring safer use of opioids at home as well as the community [29,78]. Education provided by pharmacists proved significant in optimizing opioid use, emphasizing the importance of educating both patients and healthcare providers [33,43,53]. These educational interventions could improve patient's understanding and adherence to safety practices, facilitate optimal opioid use and reduce misuse and harm while optimizing pain management outcomes. However, the complexity of conversations about opioid overdose necessitates additional training and reimbursement models to support pharmacists in their educational role [79].

The findings related to opioid risk screening programs demonstrated the value of pharmacist-led assessments in identifying risks associated with opioid use and providing patient education on safe utilization [45,46]. These programs encompassed discussions on potential risks, adverse effects, proper storage practices and appropriate medication disposal methods. Implementation of a Prescription Monitoring Program (PMR) further contributed to improved medication adherence, reduced Morphine Equivalent Dose (MED) and optimisation of both opioid and non-opioid medications [34]. The findings highlight the value of pharmacist-led opioid risk screening programs in identifying and addressing risks associated with opioid use and align with previous research, supporting the effectiveness of these interventions in risk identification, patient education and medication optimisation [80–83].

Collaborative practices between pharmacists and other healthcare providers were found to be helpful in optimizing opioid use [22,36,40,42,51,52,57,59]. Collaboration with physicians and recommendations for transitioning to non-opioid medications or optimizing buprenorphine use demonstrated positive outcomes regarding safer opioid prescribing and patient knowledge of opioid use [84]. Integration of pharmacists into the pain management teams, collaboration with physicians for methadone maintenance treatments and collaborative efforts in buprenorphine induction and treatment retention rates were associated with reduced opioid utilization, decreased high-risk prescription patterns and fewer opioid-related adverse events. The findings of this systematic review highlight the importance of collaborative practices between pharmacists and other healthcare providers in improving opioid-related outcomes.

An important gap highlighted in existing discussions is the inadequate consideration of health inequalities in managing opioid misuse and abuse. Despite documented disparities in substance use treatment, current interventions lack a focus on mitigating these disparities [85–88]. To address this, a critical re-evaluation of services aimed at managing opioid misuse and abuse is imperative to rectify existing health inequalities [88–91].

4.1. Strengths & limitations

This systematic review highlighted the role of pharmacists in addressing opioid misuse, abuse and overuse across various practice settings, indicating its generalizability. By identifying primary pharmacy services and outcomes to opioid regulation, it provides valuable evidence for policymakers to develop effective interventions.

However, the systematic review had some limitations. The search was limited to English-language published articles predominantly from the US and other high-income countries potentially restricting its applicability resource-limited healthcare systems. Nonetheless, successful experiences from these contexts can offer guidance to other countries in implementing similar services and interventions, fostering cross-country learning to tackle opioid-related challenges. The lack of studies from developing countries highlights disparities in access to opioids and other analgesic medications, emphasizing the need for research to elucidate opioid use within low-resource settings.

4.2. Implications

The study highlights the importance of integrating pharmacists' services for opioid misuse into healthcare systems, offering implications for practice, policy and future research. Policymakers can develop supportive programs based on notable outcomes, such as harm reduction and enhanced patient safety, fostering collaboration with pharmacists to optimizes care and strengthen safer opioid prescription practices across diverse healthcare settings. However, the evidence is limited, necessitating rigorous studies, including RCTs, to further evaluate pharmacists' interventions impact on patient outcomes, utilization and costs. Longitudinal studies, randomized trials and comparative effectiveness research are vital, alongside gaining insights into implementation and sustainability from stakeholders' perspectives from various healthcare settings including primary and tertiary care. Incorporating pharmacists' services can mitigate opioid misuse, enhance patient safety and guide evidence-based strategies to confront the opioid crisis. In addition, further efforts are needed to expand the scope of pharmacists' practice to minimize harm and promote optimal opioid use. Consideration of contextual factors is crucial and collaborative efforts across regions can promote knowledge sharing and develop a comprehensive global strategy for addressing opioid misuse.

5. Conclusion

This systematic review underscores the vital role pharmacists' play in addressing opioid misuse, abuse and overuse through a variety of interventions. These include naloxone administration, opioid de-escalation programs, educational initiatives, prescription monitoring, opioid risk screening and collaborative care efforts. These interventions have demonstrated positive outcomes in mitigating opioid-related harm and overdose, optimizing opioid use and pain management and improving patient safety. Importantly, these findings provide valuable insights that can inform targeted interventions to curb opioid misuse, abuse and overuse, thereby strengthening both public health efforts and healthcare practices.

Supplemental material

Supplemental data for this article can be accessed at https://doi.org/10.1080/17581869.2024.2411930

Author contributions

BKC, AA Alrasheedy, CM Christopher, Su Shrestha, Sh Shrestha contributed to conceptualization, formal analysis, investigation, methodology, validation, writing – original draft and writing – reviewing and editing. MI Mohamed Ibrahim, V Paudyal contributed to conceptualization, acquisition, resources and writing – reviewing and editing. All authors approved the final version of the manuscript for submission.

Financial disclosure

This paper was not funded.

Competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Data availability statement

All data analyzed during this study are included in this published article.

References

  • 1.Snyder B. Revisiting old friends: update on opioid pharmacology. Aust Presc. 2014;37(2):56–60. doi: 10.1111/dar.13683 [DOI] [Google Scholar]
  • 2.Haines S, Savic M, Nielsen S, et al. Opioid-related policy changes: experiences and perspectives from people who use opioids to manage non-cancer chronic pain. Drug Alcohol Rev. 2023;42(6):1482–1492. doi: 10.1111/dar.13683 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Chahl LA. Opioids-mechanisms of action. Aust Presc. 1996;19(3):63–65. doi: 10.18773/austprescr.1996.063 [DOI] [Google Scholar]
  • 4.Morgan JP. American opiophobia: customary underutilization of opioid analgesics. Adv Alcohol Subst Abuse. 1985;5(1–2):163–172. doi: 10.1300/J251v05n01_11 [DOI] [PubMed] [Google Scholar]
  • 5.Zenz M, Willweber-Strumpf A. Opiophobia and cancer pain in Europe. Lancet. 1993;341(8852):1075–1076. doi: 10.1016/0140-6736(93)92425-s [DOI] [PubMed] [Google Scholar]
  • 6.National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse . Trends in opioid use, harms, and treatment. In: Phillips JK, Ford MA, Bonnie RJ, editors. Pain Management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. Washington (DC): National Academies Press (US); 2017. [PubMed] [Google Scholar]
  • 7.World Health Organization (WHO) [Internet] . Geneva: World Health Organization; 2021. [Cited 2023 September 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/opioid-overdose [Google Scholar]
  • 8.Centers for Disease Control and Prevention . Understanding the Opioid Overdose Epidemic [Internet]. Washington DC: Centers for Disease Control and Prevention; 2023. [Cited 2023 February 23]. Available from: https://www.cdc.gov/opioids/basics/epidemic.html [Google Scholar]
  • 9.Jones MR, Viswanath O, Peck J, et al. A brief history of the opioid epidemic and strategies for pain medicine. Pain Ther. 2018;7(1):13–21. doi: 10.1007/s40122-018-0097-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Jani M, Birlie Yimer B, Sheppard T, et al. Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: a retrospective cohort study. PLoS Med. 2020;17(10):e1003270. doi: 10.1371/journal.pmed.1003270 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Ball SJ, Simpson K, Zhang J, et al. High-risk opioid prescribing trends: prescription drug monitoring program data from 2010 to 2018. J Public Health Manag Pract. 2021;27(4):379–384. doi: 10.1097/PHH.0000000000001203 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Renny MH, Yin HS, Jent V, et al. Temporal trends in opioid prescribing practices in children, adolescents, and younger adults in the US from 2006 to 2018. JAMA Pediatr. 2021;175(10):1043–1052. doi: 10.1001/jamapediatrics.2021.1832 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Ju C, Wei L, Man KKC, et al. Global, regional, and national trends in opioid analgesic consumption from 2015 to 2019: a longitudinal study. Lancet Public Health. 2022;7(4):e335–e346. doi: 10.1016/S2468-2667(22)00013-5 [DOI] [PubMed] [Google Scholar]
  • 14.Office on Drug and Crime, United Nations . World Drug Report 2023. Geneva: Office on Drug and Crime, United Nations; 2023. [cited 2023 November 29]. Available from: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html [Google Scholar]
  • 15.Gomes T, Tadrous M, Mamdani MM, et al. The burden of opioid-related mortality in the United States. JAMA Netw Open. 2018;1(2):e180217-e. doi: 10.1001/jamanetworkopen.2018.0217 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.US Mission to International Organizations in Vienna . The opioid crisis and the international response: an interview with UNODC's. Asma Fakhri. Vienna: US Mission to International Organizations in Vienna; 2021. [cited 2023 July 18]. Available from: The Opioid Crisis and the International Response: An Interview with UNODC's Asma Fakhri – U.S. Mission to International Organizations in Vienna (usmission.gov). [Google Scholar]
  • 17.European Monitoring Centre for Drugs and Drug Addiction . European Drug Report 2019. Luxemberg: European Monitoring Centre for Drugs and Drug Addiction; 2019. [cited 2023 July 18]. Available from: https://www.emcdda.europa.eu/edr2019_en [Google Scholar]
  • 18.The Royal Australian College of Physicians . Prescription opioid policy: improving management of chronic non-malignant pain and prevention of problems associated with prescription opioid use. New South Wales: The Royal Australasian College of Physicians; 2009. [Google Scholar]
  • 19.The Lancet Public Health . Opioid overdose crisis: time for a radical rethink. Lancet Public Health. 2022;7(3):e195. doi: 10.1016/S2468-2667(22)00043-3 [DOI] [PubMed] [Google Scholar]
  • 20.Liu Y, Baker O, Schuur JD, et al. Effects of rescheduling hydrocodone on opioid prescribing in Ohio. Pain Med. 2020;21(9):1863–1870. doi: 10.1093/pm/pnz210 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Rao IJ, Humphreys K, Brandeau ML. Effectiveness of policies for addressing the US opioid epidemic: a model-based analysis from the Stanford-Lancet Commission on the North American Opioid Crisis. The Lancet Regional Health. 2021;3:100031. doi: 10.1016/j.lana.2021.100031 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Jadhari R, Pathak N, Shrestha R, et al. Advancing opioid stewardship in low-middle-income countries: challenges and opportunities. J Pharm Policy Pract. 2024;17(1):2345219. doi: 10.1080/20523211.2024.2345219 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Patient Safety Network (PSNet) . Opiod Safety. Washington DC: Patient Safety Network, Agency for Healthcare Research and Quality; 2019. [cited 2023 November 5]. Available from: https://psnet.ahrq.gov/primer/opioid-safety [Google Scholar]
  • 24.Tay E, Makeham M, Laba T-L, et al. Prescription drug monitoring programs evaluation: a systematic review of reviews. Drug and Alcohol Depend. 2023;247:109887. doi: 10.1016/j.drugalcdep.2023.109887 [DOI] [PubMed] [Google Scholar]
  • 25.Islam MM, McRae IS. An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions. BMC Pharmacol Toxicol. 2014;15:46. doi: 10.1186/2050-6511-15-46 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Phelps P, Achey TS, Mieure KD, et al. A survey of opioid medication stewardship practices at academic medical centers. Hospital Pharmacy. 2019;54(1):57–62. doi: 10.1177/0018578718779005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Shrestha S, Khatiwada AP, Sapkota B, et al. What is “opioid stewardship”? An overview of current definitions and proposal for a universally acceptable definition. J Pain Res. 2023;16:383–394. doi: 10.2147/JPR.S389358 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Shrestha S, Iqbal A, Teoh SL, et al. Impact of pharmacist-delivered interventions on pain-related outcomes: an umbrella review of systematic reviews and meta-analyzes. Res Social Adm Pharm. 2024;20(6):34–51. doi: 10.1016/j.sapharm.2024.03.005 [DOI] [PubMed] [Google Scholar]
  • 29.Shrestha S, KC B, Blebil AQ, et al. Pharmacist involvement in cancer pain management: a systematic review and meta-analysis. J Pain. 2022;23(7):1123–1142. doi: 10.1016/j.jpain.2022.02.002 [DOI] [PubMed] [Google Scholar]
  • 30.Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int Surg J. 2021;88:105906. doi: 10.1016/j.ijsu.2021.105906 [DOI] [PubMed] [Google Scholar]
  • 31.Munn Z, Moola S, Riitano D, et al. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. Int J Health Policy Manag. 2014;3(3):123. doi: 10.15171/ijhpm.2014.71 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Joanna Briggs Institute . Joanna Briggs Institute reviewers' manual: 2014 edition. Australia: The Joanna Briggs Institute; 2014. [Google Scholar]
  • 33.Bjornson S, Grindeland CJ, Werremeyer AB. Impact of implementing screening and interventions to target prevention of opioid misuse and accidental overdose in the inpatient setting. J Pharm Pract. 2022;37(2):442–447. doi: 10.1177/08971900221144183 [DOI] [PubMed] [Google Scholar]
  • 34.Boren LL, Locke AM, Friedman AS, et al. Team-based medicine: incorporating a clinical pharmacist into pain and opioid practice management. PM & R. 2019;11(11):1170–1177. doi: 10.1002/pmrj.12127 [DOI] [PubMed] [Google Scholar]
  • 35.Bui T, Grygiel R, Konstantatos A, et al. The impact of an innovative pharmacist-led inpatient opioid de-escalation intervention in post-operative orthopedic patients. J Opioid Manag. 2020;16(3):167–176. doi: 10.5055/jom.2020.0565 [DOI] [PubMed] [Google Scholar]
  • 36.Lagisetty P, Smith A, Antoku D, et al. A physician-pharmacist collaborative care model to prevent opioid misuse. Am J Health-Syst Pharm. 2020;77(10):771–780. doi: 10.1093/AJHP/ZXAA060 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Lattard C, Chenailler C, Soubieux A, et al. Clinical impact of a personalized pharmaceutical plan on opioid management in non-cancer pain: a pilot study. Clin Rheumatol. 2021;40(11):4659–4663. doi: 10.1007/s10067-021-05776-7 [DOI] [PubMed] [Google Scholar]
  • 38.Mattle AG, Aladeen T, Blondell RD, et al. Evaluating outcomes of a clinical pharmacist medication management program in a multidisciplinary practice for outpatient buprenorphine treatment of opioid use disorder. JACCP. 2021;4(4):424–434. doi: 10.1002/jac5.1405 [DOI] [Google Scholar]
  • 39.McCarthy DM, Wolf MS, McConnell R, et al. Improving patient knowledge and safe use of opioids: a randomized controlled trial. Acad Emerg Med. 2015;22(3):331–339. doi: 10.1111/acem.12600 [DOI] [PubMed] [Google Scholar]
  • 40.McCarthy DM, Curtis LM, Courtney DM, et al. A multifaceted intervention to improve patient knowledge and safe use of opioids: results of the ED EMC2 randomized controlled trial. Acad Emerg Med. 2019;26(12):1311–1325. doi: 10.1111/acem.13860 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Tran T, Taylor SE, Hardidge A, et al. Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards. J Clin Pharm Ther. 2017;42(5):567–572. doi: 10.1111/jcpt.12540 [DOI] [PubMed] [Google Scholar]
  • 42.Wiedemer NL, Harden PS, Arndt IO, et al. The opioid renewal clinic: a primary care, managed approach to opioid therapy in chronic pain patients at risk for substance abuse. Pain Med. 2007;8(7):573–584. doi: 10.1111/j.1526-4637.2006.00254.x [DOI] [PubMed] [Google Scholar]
  • 43.Latif JM, Guirguis E, Henneman A, et al. Impact of pharmacy-led education regarding multimodal acute pain management on medical residents' prescribing of opioids. Hospital Pharmacy. 2021;56(1):17–25. doi: 10.1177/0018578719848736 [DOI] [Google Scholar]
  • 44.Cochran G, Chen Q, Field C, et al. A community pharmacy-led intervention for opioid medication misuse: a small-scale randomized clinical trial. Drug and Alcohol Depend. 2019;205:107570. doi: 10.1016/j.drugalcdep.2019.107570 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Frenzel O, Eukel H, Lothspeich E, et al. Opioid risk screening: program evaluation from the community pharmacists' perspective. J Am Pharm Assoc (2003). 2022;62(3):859–863.e1. doi: 10.1016/j.japh.2021.12.003 [DOI] [PubMed] [Google Scholar]
  • 46.Jacobs SC, Son EK, Tat C, et al. Implementing an opioid risk assessment telephone clinic: outcomes from a pharmacist-led initiative in a large Veterans Health Administration primary care clinic, December 15, 2014-March 31, 2015. Subst Abus. 2016;37(1):15–19. doi: 10.1080/08897077.2015.1129527 [DOI] [PubMed] [Google Scholar]
  • 47.Jaffray M, Matheson C, Bond CM, et al. Does training in motivational interviewing for community pharmacists improve outcomes for methadone patients? A cluster randomized controlled trial. Int J Pharm Pract. 2014;22(1):4–12. doi: 10.1111/ijpp.12049 [DOI] [PubMed] [Google Scholar]
  • 48.Lea T, Sheridan J, Winstock A. Consumer satisfaction with opioid treatment services at community pharmacies in Australia. Pharmacy World Sci. 2008;30(6):940–946. doi: 10.1007/s11096-008-9257-9 [DOI] [PubMed] [Google Scholar]
  • 49.Manzur V, Mirzaian E, Huynh T, et al. Implementation and assessment of a pilot, community pharmacy-based, opioid pain medication management program. JAPhA. 2020;60(3):497–502. doi: 10.1016/j.japh.2019.11.029 [DOI] [PubMed] [Google Scholar]
  • 50.Taylor SR, Chaplin MD, Hoots K, et al. Effectiveness of implementing a naloxone screening tool in a community pharmacy. Addict Disord Their Treat. 2020;19(3):142–145. doi: 10.1097/ADT.0000000000000193 [DOI] [Google Scholar]
  • 51.Wu LT, John WS, Ghitza UE, et al. Buprenorphine physician-pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network. Addiction. 2021;116(7):1805–1816. doi: 10.1111/add.15353 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Wu LT, John WS, Morse ED, et al. Opioid treatment program and community pharmacy collaboration for methadone maintenance treatment: results from a feasibility clinical trial. Addiction (Abingdon, England). 2022;117(2):444–456. doi: 10.1111/add.15641 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Ball SJ, McCauley JA, Pruitt M, et al. Academic detailing increases prescription drug monitoring program use among primary care practices. JAPhA. 2021;61(4):418–424.e2. doi: 10.1016/j.japh.2021.02.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Binswanger IA, Rinehart D, Mueller SR, et al. Naloxone co-dispensing with opioids: a cluster randomized pragmatic trial. J Gen Intern Med. 2022;37(11):2624–2633. doi: 10.1007/s11606-021-07356-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Manchikanti L, Manchukonda R, Damron KS, et al. Does adherence monitoring reduce controlled substance abuse in chronic pain patients? Pain Physician. 2006;9(1):57. [PubMed] [Google Scholar]
  • 56.Poirier RH, Brown CS, Baggenstos YT, et al. Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety. Am J Health-Syst Pharm. 2019;76(1):17–25. doi: 10.1093/ajhp/zxy003 [DOI] [PubMed] [Google Scholar]
  • 57.Seal KH, Rife T, Li Y, et al. Opioid reduction and risk mitigation in VA primary care: outcomes from the integrated pain team initiative. J Gen Intern Med. 2020;35(4):1238–1244. doi: 10.1007/s11606-019-05572-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Antoniou T, Men S, Tadrous M, et al. Impact of a publicly funded pharmacy-dispensed naloxone program on fatal opioid overdose rates: a population-based study. Drug Alcohol Depend. 2022;236:109473. doi: 10.1016/j.drugalcdep.2022.109473 [DOI] [PubMed] [Google Scholar]
  • 59.DiPaula BA, Menachery E. Physician-pharmacist collaborative care model for buprenorphine-maintained opioid-dependent patients. J Am Pharm Assoc (2003). 2015;55(2):187–192. doi: 10.1331/JAPhA.2015.14177 [DOI] [PubMed] [Google Scholar]
  • 60.Hoefling AD, Ash LR, Linneman TW. Impact of pharmacist contact via telephone vs letter on rate of acquisition of naloxone rescue kits by patients with opioid use disorder. Subst Abus. 2021;42(4):625–629. doi: 10.1080/08897077.2020.1809606 [DOI] [PubMed] [Google Scholar]
  • 61.Smith R, Tran S, Stevens S, et al. Clinical pharmacy initiative to increase naloxone prescribing in patients with opioid use disorder. JACCP. 2022;5(2):174–179. doi: 10.1002/jac5.1568 [DOI] [Google Scholar]
  • 62.Frenzel O, Eukel H, Lothspeich E, et al. Opioid risk screening: program evaluation from the community pharmacists' perspective. J Am Pharm Assoc (2003). 2022;62(3):859–863.e1. doi: 10.1016/j.japh.2021.12.003 [DOI] [PubMed] [Google Scholar]
  • 63.Cheen MHH, Goon CP, Ong WC, et al. Evaluation of a care transition program with pharmacist-provided home-based medication review for elderly Singaporeans at high risk of readmissions. Int J Qual Health C. 2017;29(2):200–205. doi: 10.1111/acem.13860 [DOI] [PubMed] [Google Scholar]
  • 64.Thakur T, Frey M, Chewning B. Pharmacist services in the opioid crisis: current practices and scope in the United States. Pharmacy. 2019;7(2):60. doi: 10.3390/pharmacy7020060 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65.Kosobuski L, O'Donnell C, Koh-Knox Sharp CP, et al. The role of the pharmacist in combating the opioid crisis: an update. Subst Abuse Rehabil. 2022;13:127–138. doi: 10.2147/SAR.S351096 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Belzak L, Halverson J. The opioid crisis in Canada: a national perspective. Health Promot Chronic Dis Prev Can. 2018;38(6):224–233. doi: 10.24095/hpcdp.38.6.02 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Butler SF, Black RA, Cassidy TA, et al. Abuse risks and routes of administration of different prescription opioid compounds and formulations. Harm Reduc J. 2011;8(1):29. doi: 10.1186/1477-7517-8-29 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Brown R, Morgan A. The opioid epidemic in North America: implications for Australia. Trends Issues Crime Crim. 2019;(578):1–15. doi: 10.52922/ti04060 [DOI] [Google Scholar]
  • 69.Gustafsson M, Matos C, Joaquim J, et al. Adverse drug reactions to opioids: a study in a national pharmacovigilance database. Drug Saf. 2023;46(11):1133–1148. doi: 10.1007/s40264-023-01351-y [DOI] [PubMed] [Google Scholar]
  • 70.Tilli T, Hunchuck J, Dewhurst N, et al. Opioid stewardship: implementing a proactive, pharmacist-led intervention for patients coprescribed opioids and benzodiazepines at an urban academic primary care centre. BMJ Open Quality. 2020;9(2):e000635. doi: 10.1136/bmjoq-2019-000635 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 71.Cid A, Ng A, Ip V. Addressing the opioid crisis-the need for a pain management intervention in community pharmacies in Canada: a narrative review. Pharmacy. 2023;11(2):71. doi: 10.3390/pharmacy11020071 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Thapa P, Lee SWH, KC B, et al. Pharmacist-led intervention on chronic pain management: a systematic review and meta-analysis. Br J Clin Pharmacol. 2021;87(8):3028–3042. doi: 10.1111/bcp.14745 [DOI] [PubMed] [Google Scholar]
  • 73.Iqbal A, David Knaggs R, Anderson C, et al. Role of pharmacists in optimizing opioid therapy for chronic non-malignant pain; A systematic review. RSAP. 2022;18(3):2352–2366. doi: 10.1016/j.sapharm.2020.11.014 [DOI] [PubMed] [Google Scholar]
  • 74.Substance Abuse and Mental Health Services Administration . SAMHSA Overdose Prevention and Response Toolkit. Rockville: Substance Abuse and Mental Health Services Administration; 2023. [Cited 2023 July 23]. Available from: https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf [Google Scholar]
  • 75.Gomes T, Mamdani MM, Dhalla IA, et al. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171(7):686–691. doi: 10.1001/archinternmed.2011.117 [DOI] [PubMed] [Google Scholar]
  • 76.Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1,014 patients. Anesthesiology. 1995;83(4):727–737. doi: 10.1097/00000542-199510000-00012 [DOI] [PubMed] [Google Scholar]
  • 77.Fleischman RJ, Frazer DG, Daya M, et al. Effectiveness and safety of fentanyl compared with morphine for out-of-hospital analgesia. Prehosp Emerg Care. 2010;14(2):167–175. doi: 10.3109/10903120903572301 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 78.Shrestha S, Shrestha R, Khatiwada AP, et al. Home care Pharmacy in Low-Middle Income Countries. Springer: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy; 2022. p. 1–8. [Google Scholar]
  • 79.Dayna Fondell SK, Sepulveda K, Staropoli A. Pharmacists' insights into their role in preventing opioid overdose 2020. New Jersy: Camden Coalition; 2022. [cited 2023 August 17]. Available from: https://camdenhealth.org/wp-content/uploads/2020/12/Pharmacists-insights-into-their-role-in-preventing-opioid-overdose-12.1.20.pdf [Google Scholar]
  • 80.SAMHSA . Prescription Drug Monitoring Programs: A Guide for Healthcare Providers. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016. [Cited 2023 August 11]. Available from: In Brief: Prescription Drug Monitoring Programs: A Guide for Healthcare Providers | SAMHSA Publications and Digital Products. [Google Scholar]
  • 81.Clark T, Eadie J, Kreiner P, et al. Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices 2012. Philadelphia: The Pew Chartiable Trust; 2012. [Cited 2023 June 19]. Available from: https://www.pewtrusts.org/~/media/assets/0001/pdmp_update_1312013.pdf [Google Scholar]
  • 82.Phillips J, Ford M, Bonnie R. Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use: evidence on strategies for addressing the opioid epidemic. Washington DC: National Academies of Sciences, Engineering, and Medicine; 2017. [Cited 2023 June 13]. [PubMed] [Google Scholar]
  • 83.Preuss CV, Kalava A, King KC. Prescription of controlled substances: benefits and Risks. [Updated 2023 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. [cited 2023 November 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537318/ [PubMed] [Google Scholar]
  • 84.Wu LT, John WS, Ghitza UE, et al. Buprenorphine physician-pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network. Addiction. 2021;116(7):1805–1816. doi: 10.1111/add.15353 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Acevedo A, Panas L, Garnick D, et al. Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter? J Behav Health Serv Res. 2018;45(4):533–549. doi: 10.1007/s11414-018-9586-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 86.Bui J, Waters A, Ghertner R, et al. Addressing Substance Use and Social Needs of People of Color with Substance Use Disorders. Washington, DC: U.S. Department of Health and Human Services, Office of Minority Health and Office of the Assistant Secretary for Planning and Evaluation; 2022. [Google Scholar]
  • 87.Nielsen S, Lubman DI. Time to address addiction treatment inequality in hospital settings. Lancet Public Health. 2022;7(1):e6–e7. doi: 10.1016/S2468-2667(21)00260-7 [DOI] [PubMed] [Google Scholar]
  • 88.Blanco C, Kato EU, Aklin WM, et al. Research to move policy – using evidence to advance health equity for substance use disorders. N Engl J Med. 2022;386(24):2253–2255. doi: 10.1056/NEJMp2202740 [DOI] [PubMed] [Google Scholar]
  • 89.Beatty K, Hale N, Meit M. Issue Brief: Health disparities related to opioid misuse in Appalachia, practical strategies and recommendations for communities. Appalachia: Appalachian Regional Commission; 2019. [Google Scholar]
  • 90.Altekruse SF, Cosgrove CM, Altekruse WC, et al. Socioeconomic risk factors for fatal opioid overdoses in the United States: findings from the Mortality Disparities in American Communities Study (MDAC). PLOS ONE. 2020;15(1):e0227966. doi: 10.1371/journal.pone.0227966 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 91.HSPH.HARVARD.edu [Internet] . Boston: Harvard TS Chan School of Public Health; 2023. [cited 2023 June 23]. Available from: https://www.hsph.harvard.edu/news/press-releases/substantial-racial-inequalities-despite-frequent-health-care-contact-found-in-treatment-for-opioid-use-disorder/ [Google Scholar]

Associated Data

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Data Availability Statement

All data analyzed during this study are included in this published article.

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