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The International Pharmaceutical Federation (FIP) has urged governments globally to support pharmacists to prevent and reduce patient harm associated with non-medicinal use of psychoactive substances by addressing inappropriate prescribing and removing regulatory barriers to care. 

FIP, which represents 5.5 million pharmacists, pharmacy educators and pharmaceutical scientists all over the world, conveyed the message during its world congress in Montreal last week that substance use disorders (SUDs) are a “significant public health challenge that contributes to morbidity, mortality and social disadvantage”.

The long-term prescribing of psychoactive drugs, including benzodiazepines, Z-drugs, opioids and antidepressants, has long been a public health concern because of the risk of patients becoming dependent or suffering withdrawal symptoms. 

FIP made three recommendations; discourage the non-medicinal use of psychoactive substances obtained through medical pathways; prevent the development of SUDs including those arising from inappropriate prescribing or medicine use; and support the prevention, early identification and management of SUDs.

FIP defined non-medicinal use as “misuse of prescription medicines other than as prescribed, including use for non-therapeutic purposes, use by individuals for whom the medicine was not prescribed or use in a manner or for a duration inconsistent with clinical guidance”.

FIP, who also cited the “use of fraudulent prescriptions to obtain prescription-only medicines” as a concern, said “underserved populations” such as the homeless, people in prison, migrants, refugees, adolescents and young adults, women, people with mental health conditions and those living in rural or remote areas, should have equal access to care.

Identify patterns of misuse

FIP said pharmacists can “strengthen prevention-oriented services including early identification of substance-related risks, brief interventions and referral to appropriate care pathways”. It said pharmacists can identify “patterns of misuse, diversion, iatrogenic origin and high-risk combinations of medicines through digital health technologies” such as electronic prescription monitoring systems.

FIP also said that because SUDs are “frequently associated with mental health conditions”, pharmacists should work closely with mental health professionals and mental health services. 

In terms of treatment support such as opioid agonist therapy and medication-assisted treatment programmes, FIP said pharmacists can “contribute through supervised administration, adherence support, patient counselling and, where authorised, collaborative prescribing or dose adjustment”.

One of FIP’s key messages was “unnecessary regulatory barriers to pharmacist provision of opioid antagonists such as naloxone” should be reduced. In the UK, naloxone can be supplied without prescription by certain groups including pharmacy teams.

In its policy statement, FIP said: “Governments, professional organisations, educational institutions, health system funders, pharmaceutical manufacturers and pharmacists themselves (should) strengthen workforce capability, remove unnecessary barriers to care, support sustainable service delivery and promote integrated, patient-centred approaches that improve health outcomes and reduce harms associated with psychoactive substance use.”

Dr Andrew Gray, co-chair of FIP’s policy committee, said: “Supporting people affected by substance use disorders requires compassion, collaboration and evidence-based care.

“Pharmacists can make a meaningful contribution not only through treatment support but also by preventing problems before they develop, empowering patients and strengthening integrated care pathways within their communities.”