Pharmacists Offer Patients Lifelines as Opioid Misuse Challenge Persists

As one of several defining public health crises of the 21st century, the opioid epidemic in the United States continues to claim tens of thousands of lives annually. Efforts to curb prescription opioid abuse have yielded positive results, but the rise of black market heroin laced with fentanyl, a synthetic opioid that can be deadly even in small doses, has added new challenges in recent years.

Pharmacists have become an essential part of the country’s strategy to combat opioid overdoses. In particular, the expanded role of pharmacists in opioid use disorder (OUD) treatment, overdose prevention, and misuse mitigation reflects the broader changes in opioid regulations and pharmacy practice that have expanded since 2023. With prescription monitoring programs (PMPs), the increasing availability of life-saving interventions like naloxone, and new federal action, pharmacists are more directly involved in patient care than ever before.

Current State of the Opioid Epidemic

During the COVID-19 pandemic, a disruption in access to treatment and recovery services, as well as increased social isolation and stress, contributed to a surge of overdose deaths. This trend culminated in 2023, when an estimated 110,037 people died from drug overdoses. However, provisional Centers for Disease Control and Prevention (CDC) data indicated a sharp 26.9% decline in overdose rates in 2024. If these numbers prove accurate, 2024 will have had the lowest overdose death toll since 2019. Almost all states shared in this improvement; many, including Michigan, Ohio, and West Virginia, experienced declines exceeding 35%. A few states, including Nevada and South Dakota, saw slight increases.

Despite this encouraging data, the annual number of lives lost to opioid overdoses remains high, and ending the opioid crisis is a top priority in improving and protecting public health.

Pharmacists’ Expanding Role in Treating OUD

For many years, pharmacists have played an increasingly integral role in addressing the opioid epidemic, and most recently, more pharmacists are providing services related to helping patients manage OUD medication treatment.

One significant regulatory shift occurred when the X-waiver was repealed, allowing pharmacists with a Drug Enforcement Administration (DEA) registration that includes Schedule III authority to prescribe buprenorphine without the need for an additional waiver or certification. This regulatory change was part of the Mainstreaming Addiction Treatment Act of 2021 (MAT Act), which created a way for pharmacists to be further engaged in the treatment of OUD.

Buprenorphine is now widely recognized as a key component in medication treatment for OUD. DEA’s elimination of the X-waiver requirement was intended to make buprenorphine more accessible to patients, especially in underserved or rural areas where there are often fewer health care providers available to assist patients. This change also paved the way for pharmacists to become more involved in direct patient care for individuals with OUD, offering a crucial support option for those in treatment.

In many states, pharmacists use collaborative practice agreements to work directly with prescribers to initiate and manage OUD treatment plans. Since nearly 90% of the US population lives within 5 miles of a pharmacy, pharmacists’ ability to engage in OUD treatment provides significant access for patients seeking help. For example, a pilot study demonstrated that when pharmacists managed buprenorphine therapy for patients, they were more likely to remain in treatment, showing an 89% retention rate after 1 month compared to just 17% for patients receiving standard care through clinics.

Pharmacy-Based Overdose Prevention

Overdose prevention is another critical area where pharmacists have proved to be effective. With illegally manufactured fentanyl being involved in more than 70% of overdose deaths, naloxone has become a key tool in preventing death.

In most jurisdictions, pharmacists are encouraged (and in some cases, required) to distribute naloxone to anyone at risk of overdose, including patients who are prescribed high doses of opioids or benzodiazepines. This may also include individuals with a history of OUD in their families. Pharmacies have also implemented naloxone distribution programs, making the drug widely available.

Pharmacists have also helped to distribute fentanyl test strips in states that have eliminated them as drug paraphernalia. As a harm reduction tool, these strips can help individuals determine whether illicitly purchased drugs contain fentanyl. Several states have also authorized pharmacies to provide these tools to individuals who are at elevated risk.

Continued Efforts to Prevent Abuse and Diversion of Prescription Opioids

While illicit opioid use is now the primary driver of the overdose crisis, prescription opioid misuse remains a significant contributor to opioid addiction and fatalities. In 2023, CDC reported approximately 13,000 deaths involving prescription opioids, including oxycodone, hydrocodone, and fentanyl, that were prescribed for medical use. Pharmacy regulators continue to refine policies aimed at preventing the misuse and diversion of prescription opioids while also balancing the needs of patients who have a legitimate need for these medications.

One of the most effective strategies has been the expansion and widespread use of PMPs, which track the dispensing of controlled substances (CS) in near real time. The integration of PMP data into pharmacy workflows and electronic health records has become common and helped prevent “doctor shopping” and other behaviors that could indicate prescription drug abuse or misuse. NABP’s PMP InterConnect® has also provided a method for reviewing prescription histories across state lines, making it harder for bad actors to cross state lines to get around limitations.

Help Protect Your Patients from the Opioid Crisis

Pharmacists should engage with prescribers to verify the authenticity and appropriateness of the prescriptions if they suspect prescription misuse. In certain circumstances, pharmacists should refuse to fill questionable prescriptions. This requires a balance of vigilance and compassion, as pharmacists must assess each situation carefully to avoid preventing legitimate access to pain relief.

Patient education has also been an important piece of pharmacist-led efforts to combat the opioid crisis. Educate your patients and their caregivers about the risks of opioid overdose, how naloxone works, and when it should be used. Share education resources from our consumer-based website, safe.pharmacy, with your patients.

This blog was adapted from an article that originally appeared in the September/October 2025 issue of Innovations.