Elevating the Essential Role of Pharmacists in Treating Substance Use Disorder

The perception of a pharmacist as someone behind a counter counting out pills is seriously outdated.

“Pharmacists are one of the most underutilized professions. I don’t think the public has taken advantage of their expertise,” says James J. Gasper, PharmD, a Board Certified Psychiatric Pharmacist (BCPP) with the California Department of Health Care Services.

According to Gasper, pharmacists today are “stewards of medications who control the drug supply.” They work in many different venues—hospitals, clinics, managed care, privately owned pharmacies and a very few, like him, specialize in psychiatry and substance use disorder.

Gasper uses his expertise and passion for treating substance use disorders to educate other pharmacists, health care providers and public health professionals about improving the care and outcomes for people with psychiatric illnesses. He’s conducted research, published data, presented to Board of Pharmacy advocating for pharmacists to be involved in substance use disorder treatment. In addition, he’s a preceptor for psychiatric pharmacy residents at Zuckerberg San Francisco General Hospital, a member of the technical expert panel on the use of emergency medications for the National Association of State EMS Officials and consultant to health departments throughout California.

“Stigma is the final frontier in this. Too many people believe that addiction is a choice, a moral failing, an illegal activity, rather than a treatable disease. We have to normalize the conversation . . . in health care, schools, workplaces, advertising, social media.”

He came to his career through a “purely nerdy academic interest in the brain.” As an undergrad major in biology at the University of Denver, he discovered a copy of Robert Julien’s book, A Primer of Drug Action, considered the definitive guide to the effects of psychoactive drugs on the brain. After reading it cover to cover, he talked his way into an upper-level course on neuropharmacology. The professor told him that if he wanted to apply his interests to human beings, instead of research, he should go to pharmacy school.

 After completing a specialized residency at UCSF, Gasper began working for the San Francisco Department of Public Health treating mental health and substance use disorders. This was in 2004 just as buprenorphine, the first drug available outside of an opioid treatment program to treat opioid addiction, was first introduced in San Francisco.

 Six years ago, he left his position to work for the California Department of Health Care Services (DHCS) to spread the lessons learned in San Francisco to other parts of the state, especially rural areas that have the highest overdose rates with the fewest resources.  

 Gasper says, “The greatest threat to someone’s mortality is always their addiction to opioids. You don’t drop dead tomorrow from high blood pressure or diabetes. But opioid addiction is an immediate threat and the reason why people lose their jobs and their relationships, get picked up by law enforcement or end up in the hospital.”

 Gasper is motivated to do this work by getting more primary care physicians on board to treat patients with substance use disorder in their clinics. He adds, “Opioid addiction is by far the easiest disease to treat. We have highly effective and well tolerated tools. We just have to give them to people.”

 Day by day, year by year, he’s making a real difference. Within a few years of joining the DHCS, he says that they’ve gone from treating a few thousand people a year with buprenorphine within the Medi-Cal system to treating over 30,000 people annually.

 To do even better, he believes that every county needs to have universal low-barrier access to treatment, clinics and pharmacists with a 24/7 drop-in center where someone can show up and get help no matter what drug they’re using.

 Gasper also advocates for changing the conversations about drug use. He says, “Stigma is the final frontier in this. Too many people believe that addiction is a choice, a moral failing, an illegal activity, rather than a treatable disease. We have to normalize the conversation . . . in health care, schools, workplaces, advertising, social media. People are fairly comfortable talking openly about physical health, but less comfortable talking about mental health. One in five people suffer from depression.”

 He adds, “The scariest thing about addiction is how hidden it is. I’ve worked with pharmacists in recovery in every state. They’re the last people to come forward. Psychiatrists are dying from suicide because they won’t talk about their depression. It’s uncomfortable, but people need to keep speaking matter-of-factly about how they’re feeling.”

 What keeps him motivated? Gasper says, “It’s knowing that the work that I’ve done and continue to do has given voice to underserved people who otherwise wouldn’t be receiving treatment and the care they need, and consistently and diligently looking for people who have not been treated well by the healthcare system. That’s what keeps me going.”