Thom Stambaugh, RPh, President, Specialty and Chief Clinical Officer, Altruix

In the past decade, the opioid crisis in the United States has received a lot of attention, inspiring documentaries, books, and pop songs. Increased awareness, along with better tools such as naloxone, more community resources, and a reduced stigma surrounding mental health, show progress in the way our society views and reacts to the crisis. Unfortunately, opioids continue to wreak havoc on individuals, families, and communities across the United States. In 2022, drug deaths in the United States hit a record high and dangerous synthetics such as Fentanyl, Xylazine, and Nitazenes are making things even worse.

Substance use disorder (SUD) is a complex condition that demands innovative solutions. One promising approach in recent years has been the use of long-acting injectables (LAIs). These medications are proving to be life-saving alternatives in the battle against addiction, providing both those suffering and the healthcare providers trying to help them with a powerful tool to combat the opioid crisis.

Progress in the fight against opioids will come from a combination of new ideas, specialty services, and a caring community. Employing LAIs is one way to get to the heart of the problem and give people the chance they need to get their lives back on track.

Treatment Options for SUD

Traditional approaches to managing opioid addiction include solutions such as oral medications, psychosocial interventions, residential and outpatient programs, and support groups. A successful treatment plan typically consists of multiple approaches tailored to the physical and mental health needs of each person. These existing programs can all have a positive impact, but they each have limitations, including the risk of diversion and non-adherence.

LAIs such as Vivitrol (naltrexone) and Sublocade (buprenorphine) are a type of medication that is administered through injection and designed to release the active drug into the body over an extended period. These medications offer several advantages over traditional oral medications, particularly for cases in which sustained and consistent drug levels are essential for effective treatment.

Advantages of LAIs

Incorporating LAIs into the treatment landscape for substance abuse offers a range of advantages that have the potential to improve care and outcomes. Some of those benefits include:

Increased adherence: One of the primary challenges with traditional oral medications is ensuring compliance. LAIs address this issue by providing a sustained release of medication over an extended period. This reduces the risk of misuse and diversion, promoting safer opioid addiction treatment.

Reduced stigma: Many people with an addiction to prescription drugs avoid seeking help due to the stigma associated with the disorder. LAIs offer a discreet and convenient treatment option, allowing people to receive the care they need without judgment.

Improved outcomes: The consistent release of medication provided by long-acting injectables helps stabilize individuals, reducing cravings and withdrawal symptoms. This, in turn, increases the chances of successful recovery and rehabilitation.

Clearly, incorporating LAIs into the treatment landscape for drug use disorders helps pave the way for a more effective approach to addressing SUD.

Challenges of LAIs

Although LAIs offer several advantages in the treatment of addictive drug use, they are not without their own challenges. Some of the misgivings associated with the use of LAIs include:

Injection site discomfort: LAIs are typically administered through injections, often in the abdomen. Despite the fact that some people who struggle with SUDs are accustomed to injecting illegal drugs, many find the injection of LAIs less appealing. Even though these injections can be lifesaving, needle phobia can be a significant hurdle.

Reluctance to seek treatment: The fear of needles and injection discomfort coupled with stigma can be a deterrent to seeking LAI-based treatment, even if it could significantly improve lives. The psychological barrier associated with the administration of LAIs may prevent people from accessing a potentially effective treatment option.

Access and engagement: Some individuals may be hesitant to engage with prescriber partners due to their fear of LAIs. This can lead to missed treatment opportunities and delayed care.

Addressing these challenges requires a whole-person care approach. Healthcare providers and addiction specialists should engage in open and empathetic conversations, provide education about the benefits of LAIs, and offer support in overcoming fears and apprehensions.

The Role of Pharmacies

Pharmacies play a pivotal role in the implementation of LAI treatments for opioid addiction. Many pharmacies specialize in handling complex and high-cost medications and have staff with specialized knowledge in the field of addiction treatment and LAIs. This allows them to provide comprehensive guidance on medication management, dosing schedules, and potential adverse effects. Particularly within the context of SUD, this expertise can have a profound impact on individuals' well-being and recovery.

Pharmacies can also work closely with healthcare providers, addiction treatment centers, and insurers to ensure seamless coordination of care. As part of the care team, pharmacists offer personalized support and monitoring, ensuring that everyone receives the right medication at the right time. This level of attention can be crucial in addiction treatment, in which individual needs may vary widely.

Unlike many retail options, specialty pharmacies often have extended hours of operation and provide delivery services, making it easier for people to access their medications and stay on track with their treatment plans.

Finally, pharmacies can provide valuable data and reporting on outcomes and adherence, helping healthcare providers make informed decisions about treatment adjustments or interventions.

The Future of Opioid Addiction Treatment

The use of LAIs in the treatment of SUD holds significant promise. As the landscape of opioid addiction and dangerous illegal drugs such as fentanyl continues to evolve, LAIs are poised to play an increasingly central role.

LAIs offer more stability and consistency in medication delivery, reducing cravings and withdrawal symptoms. As providers and healthcare professionals recognize the potential of LAIs, many are actively transitioning from oral options to injectables. As a cornerstone of treatment, ongoing research into LAIs aims to further establish their efficacy.

New dosing options are emerging, allowing for more tailored treatment plans. Weekly LAI dosing options ensure access to both medication and counseling components, and allow for more frequent check-ins and monitoring, leading to better behavioral health outcomes. This approach can help stabilize individuals so they make more rapid progress.

As the popularity of LAIs grows, pharmaceutical manufacturers are investing in innovations to improve the delivery of these medications. This includes the development of smaller needle sizes and more user-friendly delivery methods.

Individuals considering LAIs should understand that, as it stands today, LAIs are among the most effective ways to treat SUD and mitigate the negative consequences that can come from a prescription drug overdose. These medications offer consistent and reliable support in managing addiction.

Conclusion

The opioid crisis is a complex and devastating public health issue, but LAIs, supported by pharmacies, offer a ray of hope. These medications address some of the major challenges associated with addiction treatment, including non-adherence and stigma. By working together, healthcare providers, pharmacies, and individuals struggling with addiction can make significant strides in combating the opioid crisis and saving lives.

About the Author

Thom Stambaugh, RPh, President, Specialty and Chief Clinical Officer, joined Altruix to develop partnerships with key healthcare stakeholders, improve patient outcomes and lead the clinical direction for Altruix’s innovative pharmacy platform. Thom brings to Altruix a passion for helping people on medications achieve the best outcomes for a fair price. Prior to Altruix, Thom was the Chief Pharmacy Officer at Flipt, a high tech/high touch pharmacy benefit management company with a transparent and pass through business model. At Flipt, Thom led clinical, specialty, and benefit strategy. Thom also built Flipt's sales team from the ground up, and partnered to win their largest clients, including Novartis, J&J and Medtronic. Previously, Thom spent 23 years at Cigna, serving a wide range of roles, including Chief Pharmacy Officer, Vice President of Specialty Pharmacy, and Vice President of Value Based Partnerships. Thom's accomplishments include developing solutions at Cigna to help people with complex psychiatric conditions and controlled substance abuse get expert clinical care from behavioral specialists. In addition, Thom created value-based contracts with physician groups, pharmacies, and pharmaceutical manufacturers that incentivized each stakeholder to improve clinical outcomes and cost of care for patients on medications.