Cannabis, Substance Abuse, and the Pharmacist's Role in Patient Care

Abstract

A series of events over the past few years have brought forward conversations at the pharmacy counter that were historically unheard of, or if they did occur were whispered in the confines of the most trusted pharmacist-patient relationship.The issue at hand is the complex considerations of treating a patient who is using (or perhaps abusing) illicit drugs while under your care. The series of events that has moved this conversation out from the shadows and into the light of pharmacist care are interesting because, on the one hand, they are the result of an expanding public policy movement to, for example, decriminalization cannabis. On the other hand, they are also the result of a rampant spike in opioid misuse and abuse of both prescription medications and street drugs such as heroin. Two ends of a very long continuum.The former is a rather recent phenomenon with roots linked to several states approving the medicinal and recreational use of cannabis. As of January 2018, 30 states and the District of Columbia now provide for some form of medicinal use of cannabis despite it still being classified as a Schedule 1 drug in the Federal Controlled Substances Act. Additionally, eight states have taken an even further policy step to approve recreational use of cannabis. This policy shift and broader acceptance of cannabis may encourage patients to be more forthcoming with their pharmacist with regards to cannabis use, which is a positive step in helping the pharmacist know everything they need to know in order to evaluate the patient for potential drug interactions and other harmful effects of the drug. In this edition of JCPhP, you will have the opportunity to learn about the pharmacist's role in cannabis counseling and how to safeguard the patient from potential harm.The larger, and arguably much more serious, discussion with regards to opioids is a topic that has been gripping the headlines of American televisions, newspapers and legislative chambers of late. According to the Centers for Disease Control and Prevention National Vital Statistics System, every day in America, 115 people die from an opioid overdose. Sadly, the news stories and political fodder are so prevalent that many people have become numb to the statistics and accept that this is becoming a part of the “new normal” in America. But this is where pharmacists can have a great impact. Nearly every state in the U.S. now allows pharmacists to prescribe and/or furnish the lifesaving reversal medication naloxone hydrochloride, commonly referred to as naloxone or Narcan. This important rescue medication has become part of a dialogue that pharmacists have begun having with patients and other caregivers who are at risk—or know someone at risk—of overdose on medication opioids and other street opiates. While pharmacists have the authority to now offer and counsel patients on naloxone, there is still an acceptance gap among patients who need it the most. In this edition of JCPhP, you will have the opportunity to examine how patients are accepting naloxone after reviewing opioid safety posters as we try to ensure that pharmacists are part of the solutions to counter this devastating public health issue.Both of these important policy shifts in the U.S. demonstrate the ever-expanding, important role that pharmacists are playing to keep ourselves, our family members, and our communities healthy and safe, particularly in life-and-death situations. From Maine to Arizona, pharmacists are an important part of the health care team and can help contribute to these solutions.Jon R. Roth, MS, CAEExecutive Editor