SUBSTANCE USE DISORDER

To affirm that a patient with a substance use disorder (SUD) has a chronic condition with associated neurodevelopmental, physiologic, and psychosocial changes; further,

To recognize that dehumanizing language and stigmatization regarding SUD and persons who  use drugs (PWUD) create barriers to healthcare access and result in poor clinical outcomes; further,

To recognize the disproportionately harmful health impact that criminalization and policing practices related to SUD and PWUD have had on communities; further,

To advocate for destigmatization efforts and elimination of barriers to care for SUD and PWUD; further,

To support risk mitigation and harm reduction strategies, including syringe services programs, recognizing the roles they have in public health efforts to reduce infectious disease burden, improve access to healthcare, improve patient trust, and reduce expenditures; further,

To advocate for expansion of comprehensive medication management services provided by pharmacists for prevention, treatment, and recovery services within the interprofessional care team and throughout the continuum of care; further,

To support pharmacists leading community-based comprehensive preventive health and treatment programs; further,

To encourage longitudinal SUD training in didactic pharmacy curricula, starting with an early initiation of education; use of evidence-based practices, including risk mitigation, harm reduction, and destigmatizing communication strategies; and increasing experiential education pertaining to SUD; further,

To support and foster standardized education and training on SUD, including dispelling common misconceptions to the pharmacy workforce and other healthcare professionals.

This policy was revised in 2025 by the ASHP Board of Directors on April 3, 2025, to ensure compliance with federal law.

Rationale

Substance use disorder (SUD) is a public health crisis that has grown to epidemic levels in the United States over the past 30 years. The Department of Health and Human Services recognized it as a public health emergency in 2017. In 2019, over 70,000 people died from drug overdoses, and between June 2019 and June 2020, overdoses of synthetic opioids caused over 48,000 deaths. Additionally, the Centers for Disease Control and Prevention (CDC) estimates that the economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The National Academy of Medicine and the Department of Health and Human Services identify several populations that are at risk for SUD, including justice-involved populations; those living in rural areas; people who inject drugs; pregnant patients; children born to SUD; and those with lower incomes, insecure housing, and lacking access to health insurance. Additionally, researchers have demonstrated links between the increase in opioid overdoses and the rate of opioid prescriptions, particularly in populations in which overdoses had not been seen before. Age-adjusted rates of opioid overdose deaths from 1990 to 2017 have increased sixfold among Whites, climbed from 3.5 to 6.8 overdoses per 100,000 people among Hispanics, and among Blacks has increased from 3.5 to 12.9 per 100,000 people in the U.S. The age-adjusted rate of overdose deaths increased by 31% from 2019 (21.6 per 100,000) to 2020 (28.3 per 100,000). When considering infectious diseases, SUD had also been cited as a cause for a tripling of hepatitis C cases from 2010 to 2017 as well as increases in hepatitis B, human immunodeficiency virus, bacterial, and fungal bloodstream infections, as well as sexually transmitted infections and endocarditis.

SUD is a chronic condition with associated neurological and physiological changes, not a personal choice. Dehumanizing language and stigmatization regarding SUD and people who use drugs (PWUD) create barriers to healthcare access and result in poor clinical outcomes. In addition, criminalization and policing practices related to SUD and PWUD have disproportionately harmful health impact on communities of color.

The best approach to managing SUD is a multifaceted one that requires involvement at the community, hospital and health system, legislative, government, and provider levels. Programs must also include stakeholders from these levels at the planning, implementation, and enduring service stages to optimize uptake, adoption, and sustainability. Pharmacists are an essential team member as part of interprofessional teams and providing comprehensive medication management (CMM) for patients with SUD. Pharmacists are integrated as key team members across the continuum of care from community pharmacies, health systems, and ambulatory care settings. Clear communication and coordination are also crucial so that successes and failures can be assessed, modified, or discontinued to suit the goals of prevention, treatment, harm reduction, and recovery.

Harm reduction strategies including syringe service programs have proven effective, not only in preventing deaths from injectable drug overdoses and infections but also as a site of care for providing such additional services as vaccinations, testing, referral to infectious disease care and substance use treatment, and access to and disposal of needles, syringes, and other injection equipment. Elimination of barriers to sterile syringe access, including discouraging prescription or logbook requirements and providing methods of syringe disposal, promotes access to healthcare.

Education and tools for the pharmacy workforce that assist in supporting the needs of PWUD and patients with SUD should also incorporate specifics about destigmatization, person-first language, harm reduction strategies, evidence-based practices, and social determinants of health. Education should include efforts to recognize bias and misinformation, as these contribute to the stigma that serves as a major barrier in treating SUD.