Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

Authors

DOI:

https://doi.org/10.5055/jom.2021.0621

Keywords:

naloxone, harm reduction, support person, counseling, primary care

Abstract

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.

Design: Prospective quality improvement intervention in an academic family medicine clinic.

Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.

Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.

Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

Author Biographies

Julienne K. Kirk, PharmD, CDE, BCPS

Department of Family and Community Medicine, Medical Center Boulevard, Wake Forest School of Medicine, Diabetes and Endocrinology Center, Wake Forest Baptist Health, Winston-Salem, North Carolina

Matthew Q. Tran, PharmD

Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska

Samantha Pelc, PharmD

Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina

Katherine G. Moore, PharmD, BCPS, BCACP

Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Northwest Community Care Network, Community Care of North Carolina, Winston-Salem, North Carolina

References

Data brief. Drug Overdose Deaths in the United States 1999-2018. CDC website. 2018. Available at https://www.cdc.gov/nchs/data/databriefs/db356_tables-508.pdf#page=.1. Accessed February 12, 2020.

NIDA: Opioid overdose crisis. National Institute on Drug Abuse website. Accessed February 12, 2020.

NIDA: North Carolina opioid summary. National Institute on Drug Abuse website. Available at https://www.drugabuse.gov/opioid-summaries-by-state/north-carolina-opioid-summary. Accessed February 12, 2020.

Still not enough naloxone where it's most needed. CDC website. 2019. Available at https://www.cdc.gov/media/releases/2019/p0806-naloxone.html. Accessed February 12, 2020.

CDC guidelines for prescribing opioids for chronic pain. Available at https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf [cdc.gov]. Accessed February 13, 2020.

Griffin S, Wishart B, Bricker K, et al.: Impact of a pharmacist-driven intervention on the outpatient dispensing of naloxone. J Am Pharm Assoc (2003). 2019; 59(4S): S161-S166.

Cariveau D, Fay AE, Baker D, et al.: Evaluation of a pharmacist- led naloxone coprescribing program in primary care. J Am Pharm Assoc (2003). 2019; 59(6): 867-871.

Wilson CG, Rodriguez F, Carrington AC, et al.: Development of a targeted naloxone coprescribing program in a primary care practice. J Am Pharm Assoc (2003). 2017; 57(2S): S130-S134.

Bohnert AS, Logan JE, Ganoczy D, et al.: A detailed exploration into the association of prescribed opioid dosage and overdose deaths among patients with chronic pain. Med Care. 2016; 54(5): 435-441. DOI: 10.1097/MLR.0000000000000505.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States. MMWR Recomm Rep 2016; 65(No. RR-1): 1-49. DOI: 10.15585/mmwr.rr6501e1.

National Alliance of State Pharmacies Associations: Naloxone access in community pharmacies. Available at https://naspa.us/resource/naloxone-access-community-pharmacies/. Accessed February 13, 2020.

Published

03/01/2021

How to Cite

Kirk, PharmD, CDE, BCPS, J. K., M. Q. Tran, PharmD, S. Pelc, PharmD, and K. G. Moore, PharmD, BCPS, BCACP. “Improving Harm Reduction With a Naloxone Intervention in Primary Care to Prescribe and Educate a Support Person”. Journal of Opioid Management, vol. 17, no. 2, Mar. 2021, pp. 109-13, doi:10.5055/jom.2021.0621.