Mainstreaming addiction services: How pharmacy clinics can help put an end to the heroin epidemic

I am tired of hearing tragic stories about heroin deaths. It’s time for action. I’ve spent nearly a year working with Dr. Jeremy Engel and advocacy groups from Northern Kentucky working on this problem. I have done my homework. Here’s my approach.

1. Treat heroin as an epidemic, a health threat, with social side effects. 
Throughout history, addiction was treated as a social problem, not a health care issue. Now we must adjust the War on Drugs to make it less of a War on Addicts. We want to save our sons and daughters. We have learned we cannot make much progress if all we do is shun and imprison people. Nowadays, we have medical approaches.  Here’s what’s in the arsenal.

• Naloxone. Heroin kills by suppressing respiration. Naloxone neutralizes heroin, and restores breathing. It costs $65 for a rescue kit.
• Methadone, Suboxone, and Vivitrol. These three drugs do not stop addiction, but reduce cravings, and help people progress towards recovery. They have good social side effects. They may not stop addiction, but they do stop burglaries and thefts.
• Needle exchanges remove sources of deadly infection from the streets, and provide a pathway to treatment. The risks around needle exchanges can be managed.
• Community support and education. Many anti-drug and health care groups are already on board.

2. Use the strengths of existing systems to attack the threat. 
Healthcare has an open door in every community, with protocols, privacy regulations, security set-ups, connections to regulators, connections to law enforcement, and connections to the broader economy. What might we accomplish if the healthcare system treated addiction and heroin death prevention like every other health concern? We might start with needle exchange in every place that sells flu shots. Every visit is a way to distribute Naloxone. Every visit can connect people who want to stop using drugs with treatment.

3. Work with the willing.
Not everyone is comfortable working with addicted populations, but many of us are. We must ask more groups to sign on. For example, is Kroger willing to sign on, and put Naloxone and needle exchange in its retail clinics?

4. Attend to risk.
Healthcare groups have risk management procedures in place. We see them whenever we stand in line at a grocery store pharmacy. People with drug problems are with us everywhere in our community. They bring with them real risks, but we can address them. If we do, we can make progress on this epidemic of death.



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Photo by Unknown photographer [Public domain], via Wikimedia Commons