CEimpact Podcast

Stepping up as Healthcare Advocates: The Role of the Pharmacist in Combatting the Opioid Crisis

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The opioid crisis is still among us. In fact, according to the CDC, Opioids were involved in more than 68,000 deaths in 2020, which was 8.5 times the number of opioid-involved overdose deaths in 1999. The rate of drug overdose deaths involving opioids remains high, and CDC continues to track opioid overdose deaths.

In this episode of the Level Up podcast, Ashlee is joined by Richard Logan, a deputy sheriff and pharmacy owner, as they dive into Dr. Logan's experience working within both sectors of the community.
 
 Dr. Logan discusses the future in which pharmacists play a crucial role in tackling this crisis - alongside specific steps on how to reach that future.
 
 Join us, as we explore the world of pharmacy through the eyes of a pharmacist and deputy sheriff.
 
 To learn more about the CE’s below, enroll to be a By Design Member today! 

GameChangers: Street Valium: Inadvertent Sulfonylurea Overdose 

Opioids for Pain Management - Important Changes from New Guidelines 

Dispensing Opioids for Pain Management 

Naloxone: The Essentials of Pharmacist-initiated Dispensing 

Regulatory Compliance Specialist: A Training for Pharmacy Technicians 
 
 

By Design membership links: 

https://www.ceimpact.com/training/rph-membership/ 

https://www.ceimpact.com/training/tech-by-design-membership-1yr-959/ 
 
 Community Health Worker:

Check out more about Community Health Workers here. 

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Speaker 1:

Are you ready?

Speaker 2:

I'm always ready, two things I'm not afraid of, or a camera, a microphone.

Speaker 1:

Oh gosh, should I be afraid.

Speaker 2:

Yeah, I mean, take that for what it is worth.

Speaker 1:

So I am fortunate enough to be sharing the mic today with Richard, dr Richard Logan, who was referred to us by our friend Jake, and Jake and Richard have worked together for a while and Richard's son, tripp, are good friends. Richard and Logan are good friends with Jake, and so they just have this triad, this triad of three musketeers just doing God's work. Doing the Lord's work.

Speaker 2:

Let's say we're not afraid to lift up and look under the tarp to the dark side.

Speaker 1:

Well, you know, whatever that means, I'm just happy to have a seat with you, we I always like to start off my recordings, our podcasts, off of the mic, so just to get to know each other a little bit. Five, 10, 15 minutes before we start recording. And I can tell you, unfortunately we weren't recording, but I think this is going to be a great conversation with Richard today. So, richard, thank you so much for your time, your area of expertise, what you've done in the community, and I'm excited to share your story with our audience.

Speaker 2:

I'm just happy to be here.

Speaker 1:

I'm happy that when I emailed you a while back to connect with you about this show, you were in Puerto Rico and you said I can't talk to you today because I think my wife will be upset. But I can talk to you in a couple of weeks.

Speaker 2:

It's hard to talk with a pink umbrella drink in your hand.

Speaker 1:

I know I just that's. All I requested is that you think about me when you're sitting on your margarita. Why don't you start our show today by just sharing your background and a little bit about your very unique history in the pharmacy profession? I know it's a loaded question.

Speaker 2:

Yeah, my background goes back to pharmacy school when we used to ride mules and Conestoga wagons and circle them around the pharmacy school to for everybody to keep warm around the fire. But I think probably you're most interested in my law enforcement background after, after I had been a pharmacist for probably 15 or close to 20 years, at a really good friend who was elected sheriff in our small county and he needed help. He had three deputies in himself to work 650 square miles, 365, 24, 7. And it was at the beginning of the methamphetamine epidemic and methamphetamine in our small rural county was absolutely exploding around here. So he brought on not just me but several folks to to help the sheriff's department address that Little did he know that when I started doing that in the 90s that I would enjoy being a cop and and stick with it for for 25 years.

Speaker 2:

As the methamphetamine epidemic began to wane after the DEA addressed the precursor chemicals and we started limiting the lab equipment people could get and methamphetamine changed from local manufacture to a chain of distribution, much like cocaine coming from other countries and being transported rather than manufacture locally. We we saw the the buildup of opioid issues which was really brought to us very dramatically when we arrested an old methamphetamine addict. He had been arrested multiple times for illicit manufacturing of controlled substances. He was a longtime abuser and he got arrested. And he didn't have methamphetamine on him, he had pills on him. So the the sheriff went in and, this guy being a frequent flyer, they were on a first name basis and he called the guy by name and said you have pills on you. You always have meth or are are chemicals. But what's going on? He said oh, sheriff, sheriff, nobody wants meth anymore, everybody wants pills.

Speaker 1:

Wow, what year was about what year was?

Speaker 2:

this. This was probably in the early 2000s, okay, maybe as much as 05. And immediately after that, we got together with two counties and formed a drug diversion task force across two jurisdictions in which I was involved in, and we began to investigate illicit distribution, prescribing of opioids and other narcotics or amphetamines in anything basically C2.

Speaker 1:

So you were toggling between deputy and pharmacist. You weren't only a pharmacist and you weren't only a sheriff or sorry, a pharmacist. So what was that unique toggle, when you were experiencing the throws of both of those positions?

Speaker 2:

Two vivid memories. One was we had we had served an early morning and I'm talking two or three o'clock in the morning with search warrant on a methamphetamine house and it had taken longer than than usual and it was running up to about eight o'clock. And I said to the sheriff in charge I said because I was usually the photographer for evidence, I said I've got to go, let me get my shots in because I've got to go get the pharmacy opened up. So I remember very vividly pulling up in my police car in my SWAT uniform carrying my trusty 12-kage shotgun and unlocking the door of the pharmacy and standing back and having to tell the delivery driver who met me there that morning yeah, it's okay for you to go in, I'm the pharmacist.

Speaker 2:

I'm not just a cop here to get in.

Speaker 1:

That's when both of your worlds collided.

Speaker 2:

Yeah. And then my other vivid memories are surrounding opioid drug diversion. When someone would come in and try to bill illicit prescriptions at my pharmacy, it was never a particularly good idea. One January 2nd and if you're in community practice you know what January 2nd is like no insurance works.

Speaker 2:

Everybody that didn't get their Christmas Eve or that week has all come in at the same time, wondering why everything I want is not ready at this time. And I was working that morning by myself and I heard an odd conversation which you can tell somebody's being a little too friendly, he's giving you a little too much information, but it just piqued my curiosity and my tech grabbed the prescription and walked it by me and I picked it out of her hand and I went almost through one of those police words at you.

Speaker 2:

Oh darn, this doesn't look legitimate to me. It looks like it might be legal but not legitimate. So I gave it to the tech called. Come to find out. It was a photocopy of a prescription and, as I told you, my pharmacy is at the corner of a three state area. If you stand on the parking lot of my pharmacy, in 15 minutes you can be in either Missouri, where we are, Illinois or Kentucky.

Speaker 2:

And this poor old boy had waked up in Kentucky one morning and thought well, I'm just going to go try and see if I can get this filled again because I think I need some hydros. And he sadly ended up at my pharmacy. So when I determined that it was in fact a non legitimate request for a controlled substance, which in my state is a class D felony, I waltzed out from behind the counter with my handcuffs in my hand and I said you are under arrest, handcuffed him and called one of my buddies from the sheriff's office to come get him and hold him until the end of the day, because I was just too damn busy filling prescriptions to to deal with this monkey until I got off work, which means instead of getting home at six o'clock, I got home about 10 o'clock. That night.

Speaker 2:

But I did get an ovation from every patient standing behind him in the pharmacy. It was almost worth it, but the two worlds do collide.

Speaker 1:

Yes, I could imagine. You know you said somewhere in the early 2000s that you saw this opioid crisis starting, so you were as early on. It wasn't until, I think, 2017 that we document or that we term this crisis a crisis or some type of epidemic. So in between 2005 ish to 2017, that's 12 years of opioid use, opioid problems, methamphetamine still going on, and then fast forward to 2023 and just this year alone, see impact has created and discussed and talked about with our product development team, our content team and our podcast six separate education pieces on the opioid crisis and rate. That's a range of different topics, but it's fascinating to me to hear your story dating back from 2005. I mean actually 1990s, but methamphetamine to then the transition to 2005, to early 2000s, to then the opioid problem.

Speaker 2:

I tried unsuccessfully, actually, during the height of the methamphetamine crisis to interest law enforcement in addressing illicit opioid use. Back even into the 80s we had what we would call the opioid for lunch bunch People who had come in and try to buy just two or three dollars worth of controlled substances to go out and party on absolutely not therapeutic use and nobody was real interested in it until the methamphetamine epidemic began to transition and opioids became more accessible. Yeah, it's something I've actually worked on probably since the late 80s.

Speaker 1:

Where do you envision us going from here? I mean, you've been in the throes, the weeds, as both again toggling through such a unique position and background as a police officer and also a pharmacist, a pharmacy owner. I mean you knew your patients inside, it out, and also you were protecting the community, and so I'm curious your thoughts as to what we can do today that you were trying to advocate for back in the 80s. So what is? What is the missing pieces here?

Speaker 2:

The thing I've long term, longitutantly observed and as methamphetamine began in the 90s, it was clandestine manufacture methamphetamine with local labs, locally sourced precursors, locally sourced chemicals and hydrosimmonia, organic solvents, pseudoephedrine, because it was all available rurally, which is why our rural county saw it that transition from red phosphorous method of making meth, which is a very involved process requiring fairly sophisticated laboratory equipment, to a shaken bake manufacture of small amounts of methamphetamine for personal use that can be made in a single jar. Now that jar can also blow up, but those are stories for another day. So there was a transition in methamphetamine abuse. There has also been a transition in the abuse of opioids. We originally saw a few individual prescriptions for illicit opioids for recreational purposes. Then we saw the development of pill mills. We saw local opioid entrepreneurs who would recruit people to get opioid prescriptions from their physicians, take them, pay the people for going to the physician, take the pills, sell the pills, and then we watched that type of environment transition to one to where now we have raised awareness within the medical and pharmacy community.

Speaker 2:

Now understand I'm not talking absolutes, these are generalities because there are still pockets that are a real problem. But we have seen by and large a transition of the opioids that are of most concern being imported into this country from other countries, entering into a chain of distribution that is not the pharmaceutical chain of distribution. It's an illicit chain of distribution that closely resembles crack, cocaine and now methamphetamine distribution. It used to be. We would investigate physicians, we would investigate pill mills, but then we began to raise awareness, we began to prosecute, we began to really address the chain of legitimate opioid use, because if you think there's no legitimate use for an opioid, then you've never had surgery. It has its place, but while there are still issues with that, the legitimate diversion of opioids is not what it was 10 or 12 years ago.

Speaker 1:

What is it now?

Speaker 2:

The problem is less legitimate drug diversion and more imported drugs in an illicit chain of distribution.

Speaker 1:

Is that outside the scope of us as the profession, or how can we?

Speaker 2:

You're asking personal opinion and to my personal opinion, is the illicit importation of counterfeit opioids, including those containing fentanyl, or fentanyl is pass a. There are things stronger than fentanyl now that are used. I think it is a lot outside the purview of the clinical drug supply chain. Now, that is not to say that pharmacists, physicians do not still need to adhere to the legal use, the legitimate use and the sensible use of opioids. Why prescribe a month's worth of an opioid when three days worth will do or seven days worth will do? We have done a fairly decent job of educating the professions about that sort of thing.

Speaker 1:

Yeah Well, I was reading a statistic in the data before we hopped on this call and I read a study that showed or actually no, a quotation from the CDC that from 2020 to 2021, so just in the middle of COVID opioid involved death rates increase by over 15%. So what I'm hearing from your experience is that opioid Crisis is still in effect and it's still an issue. That's one. Number two we, as pharmacists, can still engage in tools and techniques on how to prevent them. But three there's also this is it a black market? Other supply chain routes that are providing?

Speaker 2:

Absolutely, yeah, absolutely. I would not underestimate the importance of pharmacists, corresponding duty of care or opioid use. You know, I think truly for any medication use, but opioid specifically, where you have to verify that not only is an opioid legally prescribed, it has to be legitimately prescribed, there has to be that physician-patient relationship, there has to be a reason for it, there has to be an examination. You know, all of the things that go into prescription, legitimacy, beyond legality, are just as important as they ever were. The duty of the pharmacist lies within the medical community.

Speaker 2:

I mean that's when you take counterfeit pills that have been imported. A lot of them come from China, through Mexico up through cartels. That's outside of our purview. We can't help that. What we can do with that is make sure that in any household that we know of that is exposed to that that there is Narcan available, because your alternatives to Narcan are just not good. I've come across cases that I've dealt with people laying in parking lots in the process of actively dying from an opioid overdose and the only thing that saved them was Narcan we had on us.

Speaker 2:

I think the education that the DEA and the DEA program I think it's called DEA 360 or something like that has been very beneficial to the professions, not to say that it's not still an issue, but it's not the issue it used to be. The people who are going to abuse opioids seem to be getting them from other sources rather than the corner pharmacy now Generally, but we still have to maintain our vigilance. It's good pharmacy practice, right agreed.

Speaker 1:

So you have seen I mean through the 80s and the 90s and the early 2000s and then up to today the shifts in drug abuse, whether it's prescription, non-prescription, whatever that looks like methamphetamine use diverting opioids into making it something else, fentanyl lacing in all of it. Where do you envision pharmacists playing the major role Moving forward in we talked about this a little bit but really focusing on minimizing and preventing patient harm with the opioid crisis?

Speaker 2:

This is not something pharmacy can do in a vacuum. Our pharmacies are very involved in health equity initiatives, and health equity initiatives If you're not familiar with those address social determinants of health of every ilk, whether it's food insecurity or housing insecurity or drug abuse, even to smoking, things like that. These things are difficult to address from either inside the medical office, inside the jail or inside the pharmacy. We feel that the future of care for patients is taking that care to the patient at the curb, on the porch stoop, at the front door of the house where they live. We employ in my practice nine community health workers. These people, not only are they pharmacy technicians for us, they're members of the community, they're out and about. They're delivering not only the pharmacy message but the total SDOH message.

Speaker 2:

What can we do to help? I think the future of Narcan availability. I think the future of mental health treatment for opioid use disorder. I think the future of medications for opioid use disorder. I think that they lie as much in the street and on the porch as they do in the clinic. I think that's how we address it. We have to address it on a personal basis, but we have to have the resources to do it, whether it's medication, whether it's referral to behavioral health, whether it is an immediate need, even something like let's find you a place to stay so that we can address this.

Speaker 1:

I agree with you and, since you brought it up, I have to ask you. So let's talk a little bit about the community health worker and your role in this program. At CE Impact, we operationalize and help support the development of education of the community health worker programs, but you've been integral in the development and the growth and with alongside Jake and Tripp and all of your colleagues. So do you mind sharing a little bit about the background of that and what exactly is the community health worker?

Speaker 2:

Um, there's a really formal definition of community health worker that can be accessed by Googling definition of a community health worker.

Speaker 1:

Give us your best chance.

Speaker 2:

I'm going to get past that, because I have been involved with community health workers for for a good long time. Long before COVID, I attended the National Association of Community Health Workers Convention and I'm just blown away by the services they offer. Community health worker is basically someone who is either lives in a community or is familiar with the community and is a valuable community resource for referrals to either especially with community health workers to health care. Things like meals on wheels, helping get your electric bill paid these are things that and this. This is way off subject for opioids, but these are things that I love it, it's all together.

Speaker 1:

Okay, that's what we do at CE Impact. We don't just slice and dice individual one offs for pharmacy. I think that's the uniqueness of our programs is that we're here to cover all of it. We look at the pharmacist, the pharmacy profession at large, specifically pharmacists, resident pharmacists, new practitioners, technicians and all pharmacy members, including community health workers, the extension, the umbrella, and so what we do is we see the problem and we create educational resources to support people like you who are out there in the weeds doing doing the work with the community. So yeah, it's all relevant, it's all tied in.

Speaker 2:

We have found community health workers absolutely invaluable. You know if, if you have someone who doesn't know where their next meal is coming from, they don't almost did it again. They really don't care about what their blood pressure or blood sugar readings are, they're hungry. They can provide meals on wheels or took them up with the local food bank. If we can take care of one problem like that, number one, we have become a valuable resource, a trusted resource and someone who can address other issues with these people, because we're seeing as problem solvers, as caring problem solvers, and it just makes a difference.

Speaker 2:

The opioids, like hunger, like anything else, has to be addressed at a community level. Yeah, you can't, you do it. Yes, one on one, but it takes a community to really get it over. The goal line and that's what we've really strived to do in our community is use our community health workers to outreach, to cement relationships, to begin those conversations that sometimes are hard with medical professionals but are not particularly hard with a friend who comes to your house or who talks to you on the phone regularly. And it we have found that it makes a huge difference in everything from medication adherence to insurance coverage, to self care, to housing and transportation. It's just. It just goes on and on and on. Every facet of a patient's life is important in their healthcare and we try to address as many as we effectively can.

Speaker 1:

Amazing. You guys are doing great work both in the profession outside the profession.

Speaker 2:

Either that or I tell really good lies, one or the other.

Speaker 1:

I don't know. Your stories are pretty detailed so I don't know if that's a lie. I think they have to be a pretty good liar to come up with those. I just I really appreciate your time. This has been amazing. I love hearing your stories about you double dipping into professions it shares and it highlights the uniqueness of our profession. I think that's one. Sometimes we lose touch. We lose touch on that. Number two is your stories were fantastic. Number three the opportunity that community health workers still have and the ongoing need for preventing the opioid crisis and for spreading resources that are available to the community.

Speaker 2:

Think about the difference of somebody you know quite well standing in your neighborhood and saying do you have some of this Narcan stuff? What would happen if someone sold down the street fell out and you know OD'd? What would you do? That's a whole lot different than somebody looking at a pharmacist in scrubs and that pharmacist asking do you have the overdose antidote? Right, you know, it's just. It's a friendlier, safer conversation to have. It just makes a huge difference.

Speaker 1:

I agree. I agree, I we have talked about a lot of different data, a lot of different statistics and a lot of different resources that we provide for pharmacists, for technicians, for community health workers. I'm going to make sure to link all those show notes and also a way people can reach out to you if they have interest in learning more about community health worker, learning more about your pharmacy and what you do, you and trip your family own pharmacy. So I really appreciate you. Jake did a great introduction with this and so I'm hoping that he can continue to pass along some more goodies, like you. But I appreciate your time, richard. It was really nice meeting you and having you on the show.

Speaker 2:

It was absolutely my pleasure, thank you.