The Prescribing and Education of Naloxone in a Large Academic Medical Center

Abstract

The opioid epidemic has led to increased needs for opioid reversal agents which require education and counseling for proper use. The purpose of this study was to evaluate outpatient naloxone prescribing and education practices at an academic medical center to understand the current state and inform quality improvement measures. This retrospective chart review study included 439 patients that were at least 18 years old and received an outpatient prescription for naloxone between 1 July 2017 and 30 June 2018. Descriptive and demographic data were collected. The primary endpoint was whether an indication for naloxone and education on administration were documented when naloxone was initially prescribed to patients. Overall, 39% of naloxone prescriptions did not have an indication for prescribing listed in the medical record. Of those with a documented indication, concomitant benzodiazepines and history of overdose or substance abuse were most common (22% and 14%). The average morphine milligram equivalents were 165. Additionally, 69% of dispenses did not have documentation that the patient or a caregiver received education regarding the use and administration of naloxone. These findings suggest that patients are receiving naloxone for appropriate indications. Documentation of medication education is needed to ensure it is occurring and that patients are informed.

Exploring the Contribution of Pharmacists in Addressing the Opioid Crisis through Naloxone Prescriptions and Pharmacist-Led Interventions

“…[35]. Although the majority of pharmacies from one study perceived to have an area in their pharmacy that is HIPAA compliant, about 23% of pharmacies did not have a semi-private area for patient counseling [34]. This could contribute as a barrier to patient education.…”

Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder?

“…79 This was far behind indications involving prescription opioid use, totaling 39.9% (concomitant benzodiazepine use, opioid use, or MME>50, constituting 21.9%, 13.9%, and 4.1% respectively, of documented indications for naloxone prescriptions). 79 Taken together, these studies suggest that most patients prescribed naloxone are high-risk prescription opioid users who are neither OUD patients, nor the so-called “drug addicts” whose stereotypes may be projected on every naloxone prescription recipient. However, an important consideration is that this stereotyped group may disproportionately influence public perception about naloxone and those to whom it is prescribed.…”

“…78 A study conducted in a large academic medical center reported that only 14.3% of naloxone prescriptions were for the combined indications of a history of overdose and substance abuse. 79 This was far behind indications involving prescription opioid use, totaling 39.9% (concomitant benzodiazepine use, opioid use, or MME>50, constituting 21.9%, 13.9%, and 4.1% respectively, of documented indications for naloxone prescriptions). 79 Taken together, these studies suggest that most patients prescribed naloxone are high-risk prescription opioid users who are neither OUD patients, nor the so-called "drug addicts" whose stereotypes may be projected on every naloxone prescription recipient.…”