Open Access Open Access  Restricted Access Subscription or Fee Access

Coprescribing naloxone for patients on chronic opioid therapy: Lessons learned from a patient-safety initiative in primary care training sites

William Delaney, MD, Jessica Huff, MPH, MS, Sandra Mini, MD, Aiswarya Thomas, MD, Ralph Tremaglio, MD

Abstract


Objective: To describe the development and implementation of a resident-led effort to increase coprescription of naloxone in a primary care setting.

Design: An exploratory, prospective pilot project to increase coprescription rates of naloxone.

Setting: Four primary care offices in western Connecticut serving as medical home training sites for primary care residents.

Patients, Participants: All patients on chronic opioid therapy.

Interventions: Over a 2-month period, eligible patients were identified and approached to receive a naloxone coprescription.

Main Outcome Measure: Rate of coprescriptions written.

Results: Three out of four training sites were able to increase coprescription rates, and 26 percent of eligible patients were able to have a prescription written.

Conclusions: Primary care practices, particularly primary care training sites, looking to implement a coprescription initiative should take several important factors into consideration during the planning stages, including naloxone availability and availability of the patient for naloxone education. More extensive research on best practices is needed.


Keywords


opioids, primary care, naloxone, overdose, patient safety

Full Text:

PDF

References


The Joint Commission: Facts about The Joint Commission. July 29, 2015. Available at http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx. Accessed March 19, 2016.

Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006; 21: 652-655.

Berry PH, Dahl JL: The new JCAHO pain standards: Implications for pain management nurses. Pain Manag Nurs. 2000; 1(1): 3-12.

Rosenblum A, Marsch LA, Joseph H, et al.: Opioids and the treatment of chronic pain: Controversies, current status, and future directions. Exp Clin Psychoparmacol. 2008;15(5): 405-416.

Paulozzi LJ, Jones CM, Mack KA, et al.: Vital signs: Overdoses of prescription opioid pain relievers—United States, 1999-2008. Morb Mortal Wkly Rep. 2011; 60(43): 1487-1492.

Okie S: A flood of opioids; a rising tide of deaths. N Engl J Med. 2010; 363(21): 1981-1985.

The Joint Commission: Clarification of the Pain Management Standard. Vol 34, Issue 11. Oak Brook, IL: Joint Commission Perspectives®, 2014. Available at http://www.jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management_Standard.pdf. Accessed March 19, 2016.

Paulozzi LJ, Weisler RH, Patkar AA: A national epidemic of unintentional prescription opioid overdose deaths: how physicians can help control it. J Clin Psychiat. 2011;72(5): 589-592.

Dowell D, Haegerich TM, Chou R: CDC guidelines for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65: 1-49.

Wheeler W, Davidson PJ, Jones TS, et al.: Community-based opioid overdose prevention programs providing naloxone—United States, 2010. Morb Mortal Wkly Rep. 2012; 61(06): 101-105.

Kim D, Irwin KS, Khoshnood K: Expanded access to naloxone: Options for critical response to the epidemic of opioid overdose mortality. Am J Public Health. 2009; 99(3): 402-407.

Davis CS, Southwell JK, Niehaus VR, et al.: Emergency medical services naloxone access: A national systematic legal review. Acad Emerg Med. 2014; 21(10): 1173–1177.

Office of Governor Andrew M. Cuomo: Governor Cuomo announces additional budget support in fight against opioid epidemic. April 8, 2015. Available at https://www.governor.ny.gov/news/governor-cuomo-announces-additional-budgetsupport-fight-against-opioid-epidemic. Accessed September 28, 2015.

Leominster Champion: School nurses receive narcan training. Available at http://www.leominsterchamp.com/news/2015-02-06/Neighborhoods/School_nurses_receive_narcan_training.html. Accessed September 28, 2015.

RIDMAT/MRC's Naloxone and Overdose Prevention Education: Overview of the naloxone and overdose prevention education program. Quarterly report. NOPE-RI third quarter report July 2014 – September 2014. Available at https://www.riresponds.org/files/PublicFileManager.ashx?utm_source=trex&utm_medium=email&Guid=9bd816be-e79a-4949-84cc-334fae35a371. Accessed September 28, 2015.

Dwyer K, Walley AY, Langlois BK, et al.: Opioid education and nasal naloxone rescue kits in the emergency department. West J Emerg Med. 2015; 16(3): 381-384.

Office of the Chief Medical Examiner: Connecticut accidental drug intoxication deaths. Available at http://www.ct.gov/ocme/lib/ocme/tox_summary_2012-14.pdf. Accessed September 28, 2015.

Nickerson J: Connecticut first responders learn to use narcan. Washington Times. December 20, 2014. http://www.washingtontimes.com/news/2014/dec/20/connecticut-first-responders-learn-to-use-narcan/. Accessed September 28, 2015.

Connecticut General Assembly: An act concerning treatment for a drug overdose. Available at http://www.cga.ct.gov/2012/ACT/PA/2012PA-00159-R00HB-05063-PA.htm. Accessed September 28, 2015.

Connecticut General Assembly: An act providing immunity to a person who administers an opioid antagonist to another person experiencing an opioid-related drug overdose. Available at http://www.cga.ct.gov/2014/ACT/PA/2014PA-00061-R00HB-05487-PA.htm. Accessed September 28, 2015.

LawAtlas: Naloxone overdose prevention laws map. Available at http://lawatlas.org/query?dataset=laws-regulatingadministration-of-naloxone. Accessed March 19, 2016.

Mueller SR, Walley AY, Calcaterra SL, et al.: A review of opioid overdose prevention and naloxone prescribing: Implications for translating community programming into clinical practice. Subst Abus. 2015; 36(2): 240-253.

Binswanger IA, Koester S, Mueller SR, et al.: Overdose education and naloxone for patients prescribed opioids in primary care: A qualitative study of primary care staff. J Gen Intern Med. 2015; 30(12): 1837-1844.

Beletsky L, Ruthazer R, Macalino GE, et al.: Physicians’ knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose. J Urban Health. 2007; 84(1): 126-136.

The AMA Tak Force to Reduce Opioid Abuse: Help Save lives: Increase access to naloxone. Available at https://download.ama-assn.org/resources/doc/washington/opioid-naloxoneama.pdf?cb=1458407776&retrieve=yes. Accessed March 19, 2016.

Coffin PO, Behar E, Rowe C, et al.: Nonrandomized intervention study of naloxone coprescription for primary care patients receiving long-term opioid therapy for pain. Ann Intern Med. 2016 (in press).

San Francisco Department of Public Health: Naloxone for opioid safety: A provider's guide to prescribing naloxone to patients who use opioids. 2015. Available at http://prescribetoprevent.org/wp2015/wp-content/uploads/CA.Detailing_Provider_final.pdf. Accessed September 28, 2015.

Prescribe to Prevent: Available at http://prescribetoprevent.org/. Accessed September 28, 2015.

Boston Public Health Commission: How to assemble a nasal naloxone (narcan) rescue kit. Available at https://www.youtube.com/watch?v=Uq6AxrEY3Vk&feature=youtu.be. Accessed September 28, 2015.

The Connecticut Department of Mental Health and Addiction Services: How to use naloxone (narcan) brochure. Available at http://www.ct.gov/dmhas/lib/dmhas/publications/NarcanBrochure.pdf. Accessed September 28, 2015.

Connecticut Department of Social Services Medical Assistance Program: Medications for substance abuse disorders. December 2015. Provider Bulletin 2015-92. Available at http://www.ctbhp.com/providers/bulletins/2015/PB-2015-92.pdf. Accessed March 19, 2016.

Business Wire: Walgreens makes life saving naloxone available without prescription in Pennsylvania pharmacies. April 11, 2016. Available at http://www.businesswire.com/news/home/20160411005186/en/. Accessed August 2, 2016.

PR Newswire: CVS/pharmacy commits to creating safer communities through multiple prescription drug abuse prevention efforts. September 23, 2015. Available at http://www.marketwatch.com/story/cvspharmacy-commits-to-creating-safer-communities-through-multiple-prescription-drug-abuse-preventionefforts-2015-09-23-8183300. Accessed August 2, 2016.

Wilder CM, Miller SC, Tiffany E, et al.: Opioid overdose risk perception and naloxone acceptability among patients maintained on chronically prescribed opioids at the Cincinnati, VA. Drug Alcohol Dependence. 2015; 146: e23.

Aagaard EM, Gonzales R, Camargo CA, et al.: Physician champions are key to improving antibiotic prescribing quality. Jt Comm J Qual Patient Saf. 2010; 36(3): 109-116.




DOI: https://doi.org/10.5055/jom.2016.0353

Refbacks

  • There are currently no refbacks.