Development of a targeted naloxone coprescribing program in a primary care practice

Area of Science:

• Pharmacology
• Public Health
• Primary Care Medicine

Background:

• A comprehensive pain management program was established in 2012, aligning with 2016 CDC opioid prescribing guidelines.
• A gap was identified regarding naloxone coprescribing for patients on chronic opioid therapy at high risk for overdose.

Purpose of the Study:

• To develop and implement a targeted naloxone coprescribing program within a primary care setting.
• To identify patients on chronic opioid therapy eligible for naloxone based on specific risk factors.

Main Methods:

• Pharmacists embedded in a family medicine practice developed a targeted naloxone coprescribing program.
• Eligibility criteria included chronic opioid therapy with doses of 50 mg or more morphine equivalents daily (MED), concurrent benzodiazepine use, or a history of substance use disorder or overdose.
• A retrospective chart review identified eligible patients.

Main Results:

• Of 709 patients on chronic opioid therapy, 49.4% (n=350) met criteria for naloxone coprescribing.
• Only 3.4% of these patients had naloxone prescribed.
• High-dose opioid therapy (≥50 mg MED) was the primary indication (61%), followed by benzodiazepine use (37.1%).

Conclusions:

• Embedded pharmacists are well-positioned to develop targeted naloxone coprescribing programs.
• Such programs can significantly increase patient access to naloxone.
• This initiative addresses a critical gap in preventing opioid overdose deaths in primary care settings.