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Vol 3 | Issue 2 | Apr – Jun 2024                                                                                      Indian J Pharm Drug Studies | 57  

Review Article 

The Role of Pharmacists in Opioid Addiction Management 

Pallav Dave 

From, Regulatory Compliance Analyst, 604 La Fontenay Ct, Louisville, KY 40223, USA 

ABSTRACT 

Opioid addiction claims thousands of lives every year in the United States. The prevalence of misuse, abuse, and overdose continues 

to rise despite the measures and initiatives taken by the federal government and other government agencies to manage the problem. 

These efforts have led to a re-evaluation of the role different healthcare providers can play to ensure the problem is adequately 

addressed. Being one of the most accessible healthcare providers to patients under opioid therapy, pharmacists are better positioned to 

deal with opioid addiction. They dispense millions of opioids every year making them better positioned to screen for patients who are 

likely to develop an addiction problem and refer them to treatment resources before the abuse escalates to opioid use disorder (OUD). 

The aim of this review is to explore the role of pharmacists in opioid addiction management including prevention, screening, 

education, naloxone prescribing, counselling, and referral to treatment resources. The review also provides pertinent information 

regarding the current state of the opioid crisis in the US, including recent data on prevalence and opioid-related deaths. Exploring the 

role of pharmacists is instrumental in coming up with effective measures that can help in opioid addiction management.  

Keywords: Opioids, Opioid addiction management, Pharmacists, Opioid misuse, Opioid abuse, Opioid use disorder  

pioids are crucial in the management of pain. Various 

studies have established that prescription opioids are 

instrumental in managing pain, particularly in the 

short term [1,2]. However, despite their significance in the 

management of pain, prolonged use without medical 

supervision can increase the risk of dependence and lead to 

addiction. The recent 2022 data by National Survey on Drug 

Use and Health is an indication of the opioid problem in the 

US with 8.9 million people who are 12 years and older having 

misused opioids while another 6.1 million being diagnosed 

with OUD in the last year [3]. Managing opioid addiction is 

paramount considering the number of deaths attributed to 

opioid addiction. In the past two decades alone, opioid 

overdose deaths in the US have gone up significantly from 

around 21,089 in 2010 to approximately 70,000 in 2020 [4,5]. 

In 2021, deaths linked to synthetic opioids other than 

methadone were approximately 70,601.4 On average, 1 death 

in every 22 in the US in 2021 was attributed to opioid toxicity 

[6] of these deaths, the most affected are younger adults aged 

25 to 34 years [7].  

The early loss of life means years of loss of productivity. 

Abuse and misuse of opioids also increase health risks and  

Access this article online 

Received – 03rd  Jul 2023 

Initial Review – 30th Jan 2024 

Accepted – 08th Mar 2024 Quick Response Code 

complications which has a major toll on public health. In 2017 

alone, the opioid epidemic cost the US $1.02 trillion, with 

approximately $35 billion being on healthcare and treatment 

[8]. Considering the magnitude of opioid misuse, abuse, and 

OUD as exemplified by available population data, there is a 

need for measures to increase awareness of the risks 

associated with opioids and put proper addiction management 

strategies in place. An interdisciplinary approach to addiction 

management including involving different professionals in 

prescribing and managing opioid addictions can enhance 

clinical outcomes [9]. Pharmacists can be instrumental in 

addiction management because of their role in opioid 

dispensing and the training they have in medication safety and 

management [10]. This review explores the role of 

pharmacists in opioid addiction management including how 

they can help in harm reduction, prescription of naloxone for 

overdose treatment, and referral to addiction management 

resources.  

Prevalence of Opioid Misuse, Abuse, and Deaths in the US 

Recent data from the Substance Abuse and Mental Health 

Service Administration (SAMHSA), National Institute on 

Drug Abuse, and Centers for Disease Control and Prevention 

(CDC) show that opioid dependence and deaths are increasing 

in the US despite the reduction in the number of opioid 

prescribing [3,4,11]. The last two decades have recorded 

__________________________________________________ 

Correspondence to: Pallav Dave, Regulatory Compliance 

Analyst, 604 La Fontenay Ct, Louisville, KY, USA - 40223. 

Email: Pallavdav@gmail.com 

O 

mailto:Pallavdav@gmail.com


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Vol 3 | Issue 2 | Apr – Jun 2024                                                                                      Indian J Pharm Drug Studies | 58  

significant numbers of individuals affected by the opioid 

epidemic with the most being young adults [7]. According to 

the CDC, the number of opioids prescribed to patients 

increased significantly from the 1990s which corresponds to 

the rise in the number of overdoses and deaths [12]. 

Approximately, 280,000 people died from prescription-related 

opioids between 1999 and 2021 [12]. In 1999, only 3,442 

deaths were reported compared to 16, 416 deaths reported in 

2021 which is an indication of the escalation in the number of 

deaths attributed to opioids [4]. Deaths related to other opioids 

other than prescription opioids also increased significantly 

during this period. The CDC reported approximately 645,000 

deaths between 1999 to 2021 while another study reported 

422 605 deaths between 2011 and 2021 [12,6].  

In addition to deaths attributed to opioids, the number of 

people who misused or abused opioids also increased 

significantly in the last two decades. In 2022, 8.9 million 

people who were 12 years and older misused opioids [3]. 

Among these, 1.1 million were aged 18 to 25 years while 7.4 

million were adults aged 26 years and older [3]. Another 6.1 

million people had OUD with adults aged 26 years and older 

accounting for 5.4 million while those aged 18 to 25 

accounting for 424,000 [3]. The high number of people 

misusing, abusing, and dying from opioid-related deaths is 

attributed to several factors key among them being high-

volume prescribing and ease of accessibility of the drugs. The 

number of opioid prescribing has gone up in the last two 

decades with 2012 recording a prescription rate of 81.3 per 

100 persons [13]. Between 2013 to 2016, the US accounted 

for the largest per-capita consumption of opioids in the world 

[14,15].  

Although opioids play a significant role in managing pain, 

a large number of patients prescribed opioids end up abusing 

or misusing them. A study by Vowles et al [16] established 

that 21% to 29% of patients who were prescribed opioids 

ended up misusing them and another 8% to 12% developed 

OUD. Despite the decline in the rates of prescribing in recent 

years, the number of people dying from opioid-related deaths 

continues to rise showcasing a discrepancy between safe 

prescribing and opioid assess. The discrepancy could also 

mean that the number of people abusing other forms of 

opioids including heroin and synthetic opioids has increased. 

Considering the high rate of misuse and abuse associated with 

opioids, there is a need to identify individuals at risk of opioid 

addiction to ensure healthcare professionals are 

knowledgeable and can be able to intervene before the abuse 

turns to OUD.  

Risk Factors for Opioid Misuse and Abuse 

Identifying people who are at risk of opioid misuse or abuse is 

vital in fighting opioid addiction. Identifying these risks 

makes it possible to assess them and put measures in place to 

manage them effectively. Various factors increase the risk of 

opioid misuse and abuse including individual factors, 

demographic factors, pain-related factors, sociodemographic 

factors, psychosocial factors, drug-related factors, and factors 

related to alcohol and substance use disorders [17]. Although 

independently these factors are not likely to increase the risk 

of misuse, a combination of two or three increases the risk 

significantly.  

Demographically, young, white, and non-urban American 

males are more likely to have a prescription opioid misuse and 

abuse problem compared to other population groups [17,18]. 

However, this could be changing. The recent 2022 National 

Survey showed that rates of misuse were higher among 

multiracial groups at 4.5%, followed by Blacks at 4.1%, and 

Hispanics at 3.4% [3]. Whites had a misuse percentage of 

3.0% while Asians were at 1.5% [3]. One of the factors why 

prescription opioid abuse is more associated with white men is 

because the rate of prescription for opioids in emergency 

departments and primary care practices is much higher [19]. 

Emotional issues and affective distress were also identified as 

factors that increased the risk of misuse and abuse with 

women who had these problems being more likely to misuse 

or abuse opioids [17].  

Socioeconomic factors also play a crucial role in 

determining if an individual is likely to have an opioid abuse 

problem. Individuals who do not have health insurance, are 

unemployed, have work-related accidents or disability, and 

those who do not graduate high school have a higher risk of 

abuse [20,21]. One of the most consistent factors associated 

with the opioid abuse problem is a history of substance use 

disorders (SUD). Various studies have found that individuals 

who have a history of SUD are at a higher risk of opioid abuse 

[22,23]. Coincidentally, individuals who experience chronic 

pain have higher rates of SUDs [17]. According to a national 

epidemiologic survey, these rates are higher than those 

observed in the general population [24].  

Considering the rates of SUDs are higher in individuals 

struggling with chronic pain, it leaves a dilemma on how 

patients who struggle with pain can be managed effectively 

using opioids without the risk of addiction. Other risk factors 

that were associated with opioid misuse and abuse were 

mental health diagnoses including psychotic and anxiety 

disorders [22,24], pain severity [17], genetic factors [17], and 

geographical factors. With regard to geographical factors, a 

high number of opioid prescriptions were mostly concentrated 

in counties in the western and southern states [25]. Besides, 

hospitalizations related to opioid overdoses between 2000 to 

2012 were also concentrated in the South region [18]. 

Controlling for risk factors associated with misuse and abuse 

is vital in opioid addiction management. For pharmacists, 

identifying these risk factors is vital in ensuring they are 

knowledgeable and can be able to intervene to manage opioid 

addictions.  



Dave                                                                                              Role of Pharmacists in Opioid Addiction Management 

 

Vol 3 | Issue 2 | Apr – Jun 2024                                                                                      Indian J Pharm Drug Studies | 59  

Role of Pharmacists in Addressing the Opioids Epidemic  

Addressing the opioid epidemic requires the involvement of 

different healthcare providers who are in contact with patients 

being prescribed opioids. In the US, involving community 

pharmacists in dealing with opioid addiction is instrumental 

considering they dispense approximately 131 million 

prescription opioids every year [26]. Besides, pharmacists are 

knowledgeable about the mechanism of action of medications 

and are in a better place to identify patients who are at risk of 

addiction. The CDC Clinical Practice Guideline for 

Prescribing Opioids for Pain recognizes the crucial role of 

pharmacists in opioid prescription, especially their role in 

opioid dispensing and naloxone prescribing [27]. Various 

studies highlight the importance of pharmacists in ensuring 

opioid safety including prevention, surveillance, and treatment 

of OUD [28-30].  

With the help of Prescription Drug Monitoring Programs 

(PDMPs), pharmacists are better positioned to control 

prescriptions and identify patients who have a higher risk of 

opioid addiction [31]. The PDMP enables pharmacists to 

screen for opioid misuse and discuss opioid-related treatment 

with patients [32]. In addition to PDMP, pharmacists have 

access to naloxone which is instrumental in reversing opioid 

overdose. A study done in Canada established that pharmacists 

play a crucial role in the distribution of naloxone as part of the 

public health initiative in dealing with the opioid crisis [33]. 

Community pharmacies were accessible to patients and being 

a key point of naloxone distribution they were instrumental in 

preventing overdoses. Other than emergency treatment, 

pharmacists can play a crucial role in prevention, which is 

recognized as instrumental in preventing the likelihood of 

developing abuse or OUD.  

Role of Pharmacists in Addiction Management  

Pharmacists play a crucial role in opioid prescription which 

makes them better positioned to prevent misuse and abuse. 

Prevention is recognized as instrumental in dealing with 

substance use disorder and addiction management and can be 

used as an early intervention measure to deal with opioid 

addiction [31]. Prevention is recognized as instrumental in 

delaying both the onset and progression of substance use 

disorders which makes it instrumental in addiction 

management. Successful prevention of opioid addiction and 

abuse can involve a number of measures including addressing 

risk factors, screening, education, and discouraging use among 

other measures. Using models such as the Screening, Brief 

Intervention and Referral to Treatment (SBIRT) model as a 

guide to prevention can enable pharmacists to achieve optimal 

outcomes [31]. The model provides a comprehensive 

approach that allows healthcare providers to carry out 

screening, prevention, and timely referral to patients who have 

SUD [34].  

The model is vital in the management of people with SUD 

including identifying those at risk of developing the problem. 

By using the SBIRT model, pharmacists can be able to screen 

for people who have high OUD risk, initiate discussions about 

the problem, and provide interventions if necessary. Screening 

is recognized as an instrumental measure in preventing opioid 

use disorder, especially in clinical and community settings 

[28]. Using screening as an intervention measure for opioid 

addiction management has a lot of potential with some 

surveys showing that community pharmacists have a positive 

attitude towards screening and are interested in using 

screening to help patients that have OUD [35,36]. The SBIRT 

model also recommends brief intervention before referring 

patients for treatment. The main aim of the brief intervention 

is to explore an individual’s motivation to change by 

increasing their insight and awareness about risks associated 

with substance abuse [31]. 

Pharmacists can play this role effectively considering they 

are knowledgeable about the risks associated with opioid 

abuse. They are also better positioned to give advice to 

patients on the negative effects of prolonged opioid use. 

Pharmacists are also better positioned to know patients who 

need a referral to treatment resources for OUD even though 

they cannot do the referral themselves [30]. They are more 

knowledgeable about outpatient treatment centers and can 

provide this information when necessary. The SBIRT model 

has been proven instrumental in screening, initiation of 

treatment, and referral of patients that have a substance use 

disorder but its efficacy is limited because results of clinical 

trials are mixed [37,38]. Despite these limitations, it has 

various areas of strength that can prove instrumental in 

addressing opioid use disorder. For instance, it is easy to use 

and adaptable meaning it can be applied in different healthcare 

settings [31]. Providing training to pharmacists on its proper 

use can ensure positive outcomes in opioid addiction 

prevention.  

Education is an additional measure that is reported in the 

literature as being vital in addiction management. Various 

studies have found a positive correlation between education-

related activities and positive outcomes when it comes to the 

prevention of opioid misuse and abuse [10,39,40]. 

Pharmacists are better positioned to provide education to 

patients because of the important role they play in opioid 

dispensing. Different studies have noted improvements in 

patient outcomes following education-based interventions 

[30,39]. In addition to providing education to patients, 

pharmacists can also be a valuable resource for training and 

educating healthcare providers who are involved in opioid 

addiction management [10]. Considering their knowledge in 

pharmacology, they are better placed to provide training and 

continuing education to other healthcare providers involved in 

opioid addiction management such as counsellors. Their role 

in providing training is documented in research, particularly 



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Vol 3 | Issue 2 | Apr – Jun 2024                                                                                      Indian J Pharm Drug Studies | 60  

on the proper use of naloxone for patients to law enforcers and 

other community members [41,42]. 

Pharmacists also play a crucial role in addiction 

management through safe dispensing. Using PDMPs is 

recognised as one measure that can ensure safe opioid 

dispensing to prevent misuse or abuse. PDMP is a risk 

mitigation practice that is recognized as instrumental in the 

effective monitoring of opioid use by healthcare providers 

[43]. PDMPs ensure safe prescribing because they track how 

controlled substances are prescribed [10]. CDC recognises 

PDMPs as instrumental in ensuring safe prescribing because 

they provide healthcare providers with timely information 

about patients’ prescriptions and behaviours that can 

contribute to misuse or abuse [27].  

Having access to timely information and patients’ history 

of prescription opioids can enable pharmacists to have 

targeted responses to prevent misuse or abuse. Considering 

that more than 50 states have operational PDMPs, then it is a 

critical avenue for timely opioid addiction management. 

Besides, it is recommended by the CDC Clinical Practice 

Guideline as a measure that can help to determine whether 

patients are receiving opioid doses that put them at higher risk 

of overdose. However, when using risk mitigation practices 

such as PDMP it is important to acknowledge the challenges 

that pharmacists may face especially when dealing with 

customers in a customer-service setting and put measures in 

place to minimize them to be able to achieve optimal 

outcomes.  

An additional role that pharmacists can play in addiction 

management is providing medication-assisted treatment 

(MAT). MAT entails the use of the Food and Drug 

Administration (FDA) approved prescription medications to 

treat opioid addiction [10]. Examples of such medications 

include methadone, naltrexone, and buprenorphine [44]. The 

use of MAT in treating opioid addiction is proven in the 

literature. Different studies have established that the use of 

these medications is effective in reducing and treating opioid 

overdoses [44,45]. MAT helps to reduce illegal opioid use by 

reducing the craving for opioids and providing relief for 

individuals experiencing withdrawal syndrome. When used in 

treating opioid addiction, the medication has been shown to 

reduce the number of fatal overdoses [10]. Because of their 

role in opioid dispensing, pharmacists can provide MAT and 

support in substance abuse treatment centers.  

Pharmacists can also deal with opioid addiction through 

the distribution of naloxone and opioid rescue kits. Naloxone 

plays an instrumental role in opioid overdose reversal and is 

recognised as an effective measure that can help in addressing 

the opioid epidemic [31]. The role of pharmacists in naloxone 

distribution is recognised in research. Community pharmacies 

are recognised as key distribution points for naloxone because 

of their accessibility to patients [33]. In addition to being key 

distribution points for naloxone, pharmacists are recognised as 

instrumental in providing education on their proper use to 

patients and support persons including law enforcement and 

members of the community [10,31,41]. Through effective 

naloxone distribution and dispensing, pharmacists can be able 

to deal with addiction management by preventing overdoses.  

Other additional measures that can help pharmacists deal 

with opioid addiction include providing medication therapy 

management (MTM), counselling, and referral to addiction 

treatment resources. The main aim of MTM is to optimize 

patient outcomes especially when it comes to effective 

medication use [46]. This is done by identifying and 

addressing problems related to the prescribed drug problems 

such as misuse or mismanagement. Pharmacists are in a 

unique position to do MTM for opioids because of their role 

in dispensing. By using tools such as PDMP, pharmacists can 

know patients who are at risk of opioid misuse and abuse and 

intervene by either recommending medication review or 

suggesting measures that can help to address the misuse 

before it escalates. Providing counseling is also a measure that 

can help with opioid addiction management. Counseling is 

mainly done in addiction treatment and rehabilitation centers 

but pharmacists are in a unique position to provide 

counselling because of their unique role that allows them to be 

in contact with patients [47,48,49].  

Providing counselling on the risks of overdose, for 

example, can ensure that patients are more knowledgeable on 

why overdosing is risky. Pharmacists can also address the safe 

disposal of opioids and safe storage [50]. Pharmacists are also 

uniquely positioned to provide referrals to addiction treatment 

resources. Because they often interact with patients, they are 

in a unique position to identify patients who may have 

undiagnosed OUD and provide referrals to addiction treatment 

resources [28]. Pharmacists are also in a better position to 

identify resources that are available to patients within the 

community making them vital in opioid addiction 

management [50]. Chisholm-Burns et al. [10] also recognise 

that pharmacists could be instrumental in referring patients to 

MAT programs and making sure they adhere to treatment.  

The following review contributes significantly to the 

existing research by identifying the role of pharmacists as 

instrumental in dealing with opioid addiction. It provides 

different interventions that pharmacists can engage in to 

prevent opioid misuse, abuse, and OUD. Identifying different 

ways in which pharmacists can help in dealing with opioid 

addiction management, cements their role as crucial in dealing 

with the opioid epidemic being experienced in the US. 

Though the role of pharmacists is recognised as instrumental, 

several barriers exist that may hinder the effective 

implementation of the interventions discussed above. For 

instance, pharmacists may not be better positioned to provide 

screening and counseling because of the limited duration of 

interaction with the patients.  



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Vol 3 | Issue 2 | Apr – Jun 2024                                                                                      Indian J Pharm Drug Studies | 61  

Pharmacists may also not be better positioned to provide 

medication-assisted treatment (MAT) because their role is 

limited to dispensing. However, considering the enormous 

potential that pharmacists possess in opioid addiction 

management, creating an enabling environment that can 

increase their readiness to provide the above-discussed 

interventions is paramount in the opioid epidemic. Providing 

education, training, and putting guidelines in place, for 

example, are some of the measures that can ensure 

pharmacists' readiness to reduce opioid misuse and abuse. 

Although this paper clearly outlines the role that pharmacists 

can play in opioid addiction management, it has its 

limitations. The scope of this paper mainly focuses on the role 

of pharmacists in the US which makes it challenging to 

generalize results to other regions and countries affected by 

the opioid epidemic. The paper is also limited by the fact that 

rigorous data extraction is not followed. The paper only 

includes articles that the author deems applicable to inform 

this research.  

CONCLUSION 

The US is still grappling with the opioid epidemic 

necessitating measures to manage addiction and prevent 

overdose deaths. Pharmacists are recognised as instrumental 

in opioid addiction management because of the crucial role 

they play in opioid dispensing and their direct involvement 

with patients. This is particularly the case for community 

pharmacists who are in a position to identify signs of misuse 

and provide interventions before patients reach the critical 

point of addiction. Pharmacists can provide various 

interventions including prevention, screening, education, 

overdose prevention through naloxone prescribing, 

counseling, and referral to treatment resources. Using models 

such as SBIRT can help pharmacists screen for patients who 

are at risk of addiction, provide brief interventions, and refer 

them to proper treatment resources. Using tools such as PDMP 

can ensure pharmacists have access to data on patients and are 

able to identify those who are at an increased risk of opioid 

misuse and abuse. Overall, implementing these measures can 

play a crucial role in helping to reverse the worrying statistics 

about opioid prevalence and morbidity. 

Abbreviations: OUD: Opioid Use Disorder, SAMHSA: 

Substance Abuse and Mental Health Service Administration, 

CDC: Centers for Disease Control and Prevention, PDMP 

(s): Prescription Drug Monitoring Programs, MAT: 

Medication-assisted Treatment, FDA: Food and Drug 

Administration, SBIRT: Screening, Brief Intervention and 

Referral to Treatment, SUD: Substance Use Disorder, MTM: 

Medication Therapy Management. 

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How to this article: Pallav Dave. The Role of Pharmacists 

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Funding: None;               Conflicts of Interest: None Stated 

 

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https://www.cdc.gov/drugoverdose/rxrate-maps/index.html

