• August 13, 2021
  • Nirjan Bhattarai, PharmD Candidate, Student Pharmacist-Intern

While everyone’s attention has been focused on COVID-19 and its impact, another long-standing epidemic in the U.S. continues to harm hundreds of thousands of Americans each day. The Opioid Epidemic continues to rage on alongside COVID-19, and recent reports suggest that it has gotten worse.[1]

According to a report released on July 14 by the Centers for Disease Control and Prevention (CDC), deaths due to drug overdose in the United States surged to a record-breaking level during the pandemic last year. The rise from 72,000 fatalities in 2019 to 93,000 in 2020 represented an increase of nearly 30 percent.

These reports highlight the importance of keeping the community safe from opioid misuse and abuse. While opioid medications effectively treat many forms of pain and are an effective treatment for many patients, these drugs' pain relief and euphoric effects can lead to dependence, misuse, and potential abuse. Opioid medication increases the level of dopamine that is produced in the body, which leads to the feeling of euphoria. The problem with these medications is that tolerance can develop quickly (similar to alcohol). Over time, patients will need more or stronger opioid medications to get the same results to feel the effects of the medications and avoid withdrawal symptoms.

Furthermore, opiates can cause several serious side effects, including severe constipation, lowering your body’s ability to detect high carbon dioxide levels, and reducing your ability to speed up your breathing rate. Respiratory depression, or your body's inability to breathe correctly on its own, is how people usually die of an opioid overdose. [2]

Patients under 65 and those with a personal or family history of substance abuse are at higher risk for opioid misuse. In fact, 96.5 percent of cases of opioid misuse start before 21 years old, when the brain is still developing. In addition, patients with chronic pain, brain health issues, and those taking benzodiazepines (i.e., Xanax, Klonopin, Valium, etc.) are at increased risk for misuse as well. Other risk factors for opioid misuse include:

  • Using long-acting or high-dose opioids (i.e., Fentanyl, Methadone, Oxycontin),[3]
  • Use of opioids and alcohol or other nonprescription sedative medication (i.e., Benadryl),
  • Use of opioids and benzodiazepine or other prescription sedatives (i.e. Ambien),
  • Underlying respiratory problems (sleep apnea, COPD, asthma), or
  • Underlying kidney or liver disease.

Opioids play an essential part in a patient’s care plan, and each patient should consult with their health care provider and pharmacist before starting or stopping any opioid medications. Besides closely monitoring the prescribing and dispensing of opioid prescriptions at our Hartig Drug pharmacy locations, Hartig Drug has recently implemented two programs in coordination with the State of Iowa to assist in reducing opioid misuse.

Hartig Drug provides Narcan (naloxone) free to any Iowa resident at any of our Iowa locations. Narcan is a nasal spray that works by attaching to the opioid receptors and reversing the effects of opioids. In addition, Hartig Drug provides disposal kits, DisposeRx, for free that can be used to conveniently dispose of unused opioids in your home at all Iowa locations. DisposeRx is a disposal packet that you can use at home to waste your unused opioids in a quick, easy, and safe manner. Some studies suggest that up to 56 percent of individuals who misused opioids obtained their medication from a friend or family member at no cost[4], so getting rid of your opioids when you do not need them helps keep our community safe.


Narcan- How do I use it?

  • Narcan is used for emergency treatment of an opioid overdose or a possible overdose. Narcan is like keeping a fire extinguisher in your house, you hope you never have to use it, but you will be happy it is available if you need it. It will temporarily reverse the effects of opioid medications. The signs and symptoms of an opioid overdose are (1) small, constricted “pinpoint pupils,” (2) falling asleep or loss of consciousness, (3) slow, shallow breathing, (4) choking or gurgling sound, (5) limp body, and (6) pale, blue, or cold skin.[5]
  • Once suspected that someone is undergoing an opioid overdose, a caregiver/family member should call 911 and then administer Narcan. Your Hartig Drug pharmacist can provide you with counseling on using Narcan, or directions can be found here.
  • The side effects of Narcan are temporary and often mimic the signs and symptoms of opioid withdrawals (i.e., headache, joint and muscle pain, irritability, agitation, body aches, nausea or vomiting, fast or irregular heartbeat). It is crucial that a person that receives Narcan seek emergency medical care immediately.


DisposeRx- How do I use it?

  • If Narcan is the fire extinguisher, DisposeRx can be viewed as a fire safety manual. DisposeRx provides a way for patients to safely get rid of their unused opioids, eliminating the risk for somebody to get their hands on them. To use DisposeRx, follow these directions located here.
  • The contents in the DisposeRx packet are non-hazardous and non-toxic. However, it is still recommended that you call poison control if someone were to ingest it by accident.[6]


Prevention methods and reversal agents like DisposeRx and Narcan are the closest things we have to a vaccine for this opioid epidemic. Hartig Drug offers these at no cost to their community members in Iowa. Next time you stop by your Hartig Drug store, ask your pharmacist for these products if you or your loved ones take any opioid medication.


Contact your local Hartig Drug for more information. 


[1] Becker, William C, and David A Fiellin. “When Epidemics Collide: Corona virus Disease 2019 (COVID-19) and the Opioid Crisis.” Annals of Internal Medicine vol. 173,1 (2020): 59-60. doi:10.7326/M20-1210
[2] Werremeyer, Amy. Opioid Risks and Benefits. North Dakota State University. https://learn.ceimpact.com/course-landing/1933
[3] “Safe Use of Long-Acting Opioids.” Safe Use of Long-Acting Opioids | Michigan Medicine, www.uofmhealth.org/health-library/abo7833.
[4] Imarhia, Fiona et al. “Prescription drug disposal: Products available for home use.” Journal of the American Pharmacists Association : JAPhA vol. 60,4 (2020): e7-e13. doi:10.1016/j.japh.2020.01.004
[5] “Overdose Prevention.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Oct. 2020, www.cdc.gov/opioids/overdoseprevention/index.html.
[6] “Our Methodology – DisposeRx®.” – DisposeRx®, disposerx.com/page/7/our-methodology.


Nirjan Bhattarai, PharmD Candidate, Student Pharmacist-Intern

Nirjan Bhattarai, PharmD Candidate, Student Pharmacist-Intern

Nirjan Bhattarai is a Pharmacist-Intern at Hartig Drug Company. He will graduate in May 2024 from Drake University's College of Pharmacy and Health Sciences.

Originally from Jhapa, Nepal, Bhattarai's initial interest in chemistry and mathematics drew him to pharmacy. While in high school, he worked in a retail pharmacy and fell in love with the patient interaction side of pharmacy. Through pharmacy school, Bhattarai has developed a strong passion for increasing pharmacists' role in patient care and improving care for underserved community members.

Bhattarai enjoys reading, hiking, and playing soccer in his free time. During his time at Hartig Drug, he has enjoyed working with data and researching pharmaceutical topics that have given him additional tools, improving himself as a pharmacy student, and preparing him to serve his community.