Expanding Naloxone Coprescribing at a Regional VA Medical Center

Area of Science:

• Medical Sciences
• Public Health
• Clinical Pharmacy

Background:

• Veterans experience high rates of chronic pain and opioid prescriptions.
• Opioid therapy poses risks, necessitating risk mitigation strategies like naloxone coprescription.
• Specific risk factors, including high opioid dosage and concurrent sedative use, increase overdose risk.

Purpose of the Study:

• To improve naloxone coprescription rates among high-risk veterans receiving opioid therapy.
• To implement a quality improvement initiative within a Veterans Affairs (VA) medical center.
• To reduce opioid-related adverse events through proactive safety measures.

Main Methods:

• An interprofessional team developed and implemented an intervention at a VA Continuity of Care Clinic.
• Eligible patients were identified using the VA Primary Care Almanac's Opioid Therapy Risk Report.
• Providers received alerts via email and secure messaging to facilitate naloxone coprescription.

Main Results:

• Naloxone coprescription rates rose from 42% to 82% between June 2022 and June 2023.
• This represents an increase from 29 out of 69 patients to 41 out of 50 patients.
• The observed increase was statistically significant (P < 0.0001).

Conclusions:

• Proactive provider notification of high-risk patients significantly increases naloxone coprescriptions.
• Quality improvement interventions can effectively enhance opioid safety protocols in clinical settings.
• Targeted alerts are a viable strategy to improve naloxone utilization among at-risk populations.