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• W3113310085 abstract "I spent my childhood, mostly barefoot, in rural southern West Virginia, in the heart of coal country and the opioid epidemic. Opioids ravaged my Appalachian home, touching the lives of every family, regardless of income or education, and exhausting our state’s already limited resources. Growing up, I was surrounded by the deep misery caused by drugs, and I often wondered how people could choose a path so filled with despair. These experiences motivated me to pursue pharmacy practice so that I could understand how these drugs could desolate an entire state and, more importantly, so that I could learn how to help people in my community recover and rebuild their lives. The decision to seek treatment for an opioid use disorder is not easy, particularly in rural Appalachia. Patients who decide to “get clean” face numerous challenges along the way, including difficultly finding a nearby treatment facility that offers medications for opioid use disorder (MOUD), long waiting lists, major transportation obstacles and limited financial resources. In 2016, 60% of rural counties nationally did not have a physician who could prescribe buprenorphine (BUP).1Andrilla C.H.A. Coulthard C. Larson E.H. Barriers rural physicians face prescribing buprenorphine for opioid use disorder.Ann Fam Med. 2017; 15: 359-362Crossref PubMed Scopus (102) Google Scholar Of those authorized to prescribe MOUD in West Virginia, only 57% chose to be listed on the federal Substance Abuse and Mental Health Services Administration Buprenorphine Treatment Locator’s website, making treatment options difficult to find for many patients. In addition, Jones et al.2Jones C.M. Campopiano M. Baldwin G. McCance-Katz E. National and state treatment need and capacity for opioid agonist medication-assisted treatment.Am J Public Health. 2015; 105: e55-e63Crossref PubMed Scopus (409) Google Scholar found that in 2012 all 9 of West Virginia’s opioid treatment programs were at least 80% or greater capacity, and a moratorium in West Virginia prevents new methadone programs from opening. The lack of accessible programs providing MOUD makes taking the first step toward recovery difficult, and the journey seems to continue to be all uphill. Even patients who manage to get in a treatment program continue to face obstacles to maintaining their recovery. Patients who try to fill their BUP prescriptions face innumerable barriers: pharmacies refusing to accept new patients, refusing to fill legitimate prescriptions, and refusing to stock BUP and insurance delays.3Chaar B.B. Wang H. Day C.A. Hanrahan J.R. Winstock A.R. Fois R. Factors influencing pharmacy services in opioid substitution treatment.Drug Alcohol Rev. 2013; 32: 426-434Crossref PubMed Scopus (24) Google Scholar, 4Cooper H.L. Cloud D.H. Freeman P.R. et al.Buprenorphine dispensing in an epicenterof the U.S. opioid epidemic: a case study of the rural risk environment in Appalachian Kentucky.Int J Drug Policy. 2020; 85: 102701Crossref PubMed Scopus (27) Google Scholar, 5Thornton J.D. Lyvers E. Scott G.G. Dwibedi N. Pharmacists’ readiness to provide naloxone in community pharmacies in West Virginia.J Am Pharm Assoc. 2017; 57: S12-S18.e4Abstract Full Text Full Text PDF Scopus (55) Google Scholar These barriers are not only with MOUD though; the problem extends to naloxone. Thornton et al.5Thornton J.D. Lyvers E. Scott G.G. Dwibedi N. Pharmacists’ readiness to provide naloxone in community pharmacies in West Virginia.J Am Pharm Assoc. 2017; 57: S12-S18.e4Abstract Full Text Full Text PDF Scopus (55) Google Scholar reported that in 2016 only 20.4% of community pharmacists in West Virginia felt comfortable dispensing naloxone without a prescription despite existing legislation allowing such. For patients trying to achieve recovery, pharmacists may unknowingly prevent patients from receiving life-saving medications. I have worked in a community pharmacy for many years, and I understand the pharmacists’ side of the counter too. Many states, including West Virginia, have taken legal action against pharmacies, including naming them in lawsuits and claiming that pharmacists are conspirators in the opioid epidemic.6Haffajee R.L. The public health value of opioid litigation.J Law Med Eth. 2020; 48: 279-292Crossref PubMed Scopus (4) Google Scholar Federal and state government regulations only partially explain these obstacles; however, some pharmacists blame patients and hold tightly to deep-rooted stereotypes. Too often, we are quick to assume that these patients have no real interest in recovery or assume that patients are diverting their prescriptions to profit financially from the suffering people of our communities. These assumptions are pouring gasoline on an already raging fire. Pharmacists are torn because our diligence and responsibility to detect “doctor shopping” and to stop being accomplices in opioid overprescribing, are often preventing us from making the life-saving interventions that we are uniquely capable of and that the lives of many West Virginians are depending on. As a profession, we are standing at a crossroad with patients on their path to recovery, and we must make conscious choices about how we move forward. Recovery is not a one-way street or a one-size-fits-all journey. However, if we take time to listen to those who are hurting instead of dismissing them on the basis of their prescription, appearance, or demeanor, we can make a difference. Practically, we can start by building a relationship with local opioid use disorder treatment programs. We can use our professional judgment and seek out programs that incorporate evidence-based clinical approaches such as random urine drug screens, comprehensive social support, and medications such as BUP. We can partner with these clinics to provide education about insurance delays, early refills, naloxone and be honest about our patient capacity. As a profession, we can build bridges for those who are struggling to win the uphill battle of achieving recovery. Pharmacists, especially those in rural Appalachia, the place that I call home, cannot continue to sit by idly as the death toll increases. Through advocacy, honesty, and empathy, we can start to rebuild our communities, 1 prescription at a time. Emily P. Thacker, BS, Student Pharmacist, West Virginia University, School of Pharmacy, Morgantown, WV" @default.
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• W3113310085 title "Building bridges to recovery in Appalachia" @default.
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