Pharmacy research: driving safer outcomes in substance misuse

As chief scientist of the Royal Pharmaceutical Society (RPS), I witness daily how pharmacy professionals combine expertise in medicines, strong research capability and front line care. In the complex field of substance misuse, pharmacists are uniquely positioned to apply evidence in real time, support safer prescribing and strengthen harm-reduction services. Research matters here because it enables movement beyond individual experience toward approaches that are robust, measurable and consistently reproducible.

Substance misuse continues to cause significant harm across the UK, with 5,565 drug-poisoning deaths recorded in England and Wales in 2024, including 3,736 deaths attributed to drug misuse^​1​. Adulterated street drugs, diverted prescriptions and counterfeit products create unpredictable risks for people who use drugs and for the clinicians and services supporting them. One emerging concern is the group of novel synthetic opioids (commonly referred to as ‘nitazenes’), which have been detected in illicit drug supplies, including cocaine and heroin, and in some counterfeit medicines^​2–4​. Some nitazenes are highly potent; for example, isotonitazene has been reported in animal models to be around 500 times more potent than morphine^​2,5,6​. This potency may increase the risk of overdose and complicates identification and response, as initial toxicology screening may not detect them.

Prescription and over-the-counter (OTC) medicines can contribute to complex challenges, including risks of dependence, diversion into illicit channels and potentially harmful drug combinations, particularly when high-risk medicines like opioids or gabapentinoids are involved. In everyday practice, pharmacy teams see these issues first hand and play a crucial role in addressing them through structured medication reviews, patient-centred counselling, collaborative stewardship with prescribers, and proactive harm-reduction strategies to enhance safety and support better outcomes.

We are also seeing rapidly evolving risks from unregulated online sales and counterfeit medicines. For example, the Medicines and Healthcare products Regulatory Agency (MHRA) has taken enforcement action against the illicit manufacture and supply of unlicensed weight-loss medicines. In October 2025, this included a major seizure of thousands of injection pens labelled as containing tirzepatide and retatrutide, products that lacked safety and quality controls, and which therefore posed serious risks to users.

These are not abstract threats — they are real challenges faced by patients presenting to our community pharmacies, hospital wards, and drug and alcohol services every week.

Pharmacy professionals are at the heart of the response, as independent prescribers, we assess, initiate and monitor opioid agonist therapy; conduct targeted reviews for high-risk prescribing; supply naloxone directly; and provide harm-reduction counselling.

The power of pharmacy-led research lies in transforming routine practice data into reliable, actionable evidence. Large-scale cohort analyses uncover prescribing patterns; national mortality datasets reveal trends; observational service evaluations test interventions; and systematic reviews synthesise global insights for local application.

Applying robust methodology transforms data into reliable practice-changing guidance. A compelling example is the expansion of take-home naloxone, where pharmacists are now playing a pivotal leadership role in harm reduction. Since 2 December 2024, amendments to the Human Medicines Regulations 2012 have enabled registered pharmacists and pharmacy technicians (alongside other professionals such as registered nurses and midwives) to supply take-home naloxone kits without a prescription or patient group direction. This change was informed by evidence from Advisory Council on the Misuse of Drugs (ACMD) reviews, pilot programmes, and real-world data demonstrating both the barriers to timely access and the life-saving potential of wider naloxone availability^​7–10​. As a result, community-level reach has expanded significantly. 

Pharmacists can identify at-risk individuals, such as those with opioid prescriptions, a history of substance misuse or through routine interactions. They can provide practical, hands-on training in recognising and responding to overdose, supply naloxone kits tailored to individual need, and offer ongoing support and repeat provision as part of a holistic, person-centred approach to care. 

Embedding research and translating evidence

In a system where resources are already stretched, research is not an academic extra — it is what makes our daily clinical decisions safer, more efficient and more defensible. Even small, routine efforts (like tracking naloxone supplies or reviewing local prescribing patterns) can generate actionable insights that provide support during busy shifts and reassure patients.

For pharmacy teams, this means remaining alert when clinical presentations deviate from expectations and being proactive in conversations about overdose risk and naloxone, especially given that nitazenes may be present in supplies we might not immediately suspect.

Two recent original research articles published in the International Journal of Pharmacy Practice (IJPP) highlight methods that we can adapt to enhance our own practice or use to initiate local research:

1. “Factors influencing pharmacists’ roles in preventing prescription and OTC opioid misuse: a systematic review and narrative synthesis”^​11​: This review synthesises global studies to identify barriers (e.g., time constraints, training needs, attitudes) and enablers (e.g., education, harm reduction integration like naloxone) in misuse prevention. The methodology, database searching and thematic synthesis via the COM-B framework, provides a model for UK teams undertaking literature reviews or assessing local capabilities in substance misuse support;
2. “A pharmacist initiative to reduce opioid prescribing in primary care”^​12​: This retrospective evaluation of a pharmacist-led review clinic in a high-deprivation area measures reductions in strong opioid prescribing via routine electronic health records. The pre/post-intervention design with real-world data serves as a low-resource template for us in UK primary care teams seeking to audit high-risk prescribing and implement targeted, evidence-informed interventions. 

These examples demonstrate that even well-designed audits, surveys or routine dataset reviews embedded in everyday practice can generate actionable evidence that directly improves patient safety and outcomes, without requiring us to become full-time researchers.

Your next steps

Consider exploring these articles in the IJPP, published by the Royal Pharmaceutical Society in partnership with Oxford University Press. Reflect on which methodology best aligns with your setting and consider how it might inform your practice. For example, you might review naloxone supply trends in our pharmacy, gather perspectives on gabapentinoid prescribing, or assess outcomes from an opioid review initiative. 

If you are interested in publishing your own research on preventing harm from substance use disorders, find out more about an upcoming special issue here. 

As independent prescribers and researchers, we play a vital role in shaping policy and practice that is firmly grounded in evidence. The substance misuse landscape continues to evolve, with emerging threats such as nitazenes, unregulated online supply and medicine-related harms requiring ongoing attention. We can help by linking everyday clinical practice with evidence-informed improvement.

The RPS is committed to supporting pharmacists to develop, use and share evidence that improves patient outcomes. The case for action is clear. The opportunity to make a difference is now.