Pharmacist: While eyes are on opioids, methamphetamine ending lives below surface

As a practicing pharmacist I have been witness to the rise in the use of analgesic opioids and methamphetamine—at times, purchased right in front of my pharmacy.

I have practiced in retail, hospital, oncology, and home infusion pharmacy.

I have been a director of pharmacy for Blue Cross Blue Shield of Ohio, managed care pharmacy and Ohio Medicaid. Managing the legal and illicit drugs in Ohio has been challenging.

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At Medicaid, I served at the pleasure of the governor of the state of Ohio, on the governor’s Cabinet Opioid Action Team.

This was a multidisciplinary team (including coroners, dentists, veterinarians, among other professionals) whose charter was to identify illicit substance utilization, form ideas to prevent drug-related deaths, and to produce guidelines for appropriate prescribing of opioids.

During these discussions, it became very apparent that prescribing of opioids was a problem.

Medicaid was able to produce internal reports of patients being admitted to the hospital through the emergency room for overdoses.

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Patients, when drug toxicity screens were reviewed, were positive for opioids, marijuana, heroin, methamphetamine, barbiturates and benzodiazepines and alcohol, which when combined, can and often did lead to death.

Opioids and alcohol have dominated the news, but there is another drug, methamphetamine, that has been lurking in the background; It has become an epidemic.

Methamphetamine is from the “parent compound Amphetamine” and is a highly addictive stimulant that affects the central nervous and somatic systems. It differs from amphetamines in that it is more potent, lasts longer, and is harmful to the central nervous system.  

The CDC reported that the number of overdose deaths that included stimulants, primarily methamphetamine, increased 4 times from 2015 to 2020.  About 25% of all overdose deaths in 2020 involved methamphetamine. In 2020, 2.5 million Americans had used methamphetamine in the past year, from diagnoses and surveys.

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There is a bill in the 117th Congress that designates methamphetamine as an emerging drug threat. It also directs The Office of National Drug Control Policy to implement a methamphetamine response plan.

While there is a lot of known information on methamphetamine, it seems that the federal and state governments, as well as health plans, are not focused enough on the methamphetamine epidemic.

Are there remedies to assist methamphetamine addicts with recovery, and to keep them in recovery?

The answer is yes. There are clinics that offer U.S. Food and Drug Administration-approved, medication-assisted treatments, behavioral health programs, and addiction treatment programs. The most effective treatments for methamphetamine addiction are behavioral therapies.

Contingency management interventions, which provide tangible incentives in exchange for engaging in treatment and maintaining abstinence, have also been shown to be effective.

Motivational Incentives for Enhancing Drug Abuse Recovery, an incentive-based method for promoting cocaine and methamphetamine abstinence, has demonstrated efficacy among methamphetamine misusers through the National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network.

While there are programs and medication-assisted treatments available, another problem is that this can be too much for an addict to handle. While the methamphetamine addict is worrying where the next “hit” comes from, they also worry about the next meal, and where they can rest.

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Addiction treatment programs and the FDA need to collaborate as a multidisciplinary team to attack the addiction problem.

New treatment modalities, new therapeutics, and new dosage forms for existing therapeutics should be made available when sufficient efficacy and safety data are provided, so that the FDA can provide “provisional” approval status to begin to get these methamphetamine addicts the help they need.

Michael Howcroft is a registered pharmacist in Ohio and a co-founder of one of the first pharmacy benefit management companies, currently known as Anthem.

He also has worked with Gov. Mike DeWine’s office to develop provider education programs on opioids.