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Bridging the Gap: Empowering Pharmacists in Inpatient Injectable Naltrexone and Hospital-Dispensed Methadone Process

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Pharmacy-led initiatives improved access to medications for substance use disorders (SUD), including injectable naltrexone and take-home methadone. These processes addressed underutilization and supported patient transitions from hospital care.

Keywords:
alcoholisminpatientsmethadonenaltrexoneopioid‐related disorderspharmacy

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Area of Science:

  • Pharmacology
  • Addiction Medicine
  • Health Services Research

Background:

  • Substance use disorders (SUD) are prevalent, contributing significantly to hospitalizations.
  • Medications for SUD are underutilized due to various barriers, including stigma and systemic issues.

Purpose of the Study:

  • To implement and evaluate pharmacy-led processes for hospital-administered intramuscular naltrexone (IM-NTX) and hospital-dispensed methadone at discharge.
  • To overcome barriers to medication access for patients with SUD within an academic hospital setting.

Main Methods:

  • Developed pharmacy-led workflows for IM-NTX administration and methadone dispensing at discharge.
  • Key steps included provider ordering, pharmacist verification, preparation, administration, chain of custody, and patient education.
  • Data collected from December 2022 to May 2025 on order volumes, patient numbers, and medication utilization.

Main Results:

  • 323 IM-NTX orders were placed, with 225 doses administered to 248 unique patients, primarily for alcohol use disorder.
  • 231 methadone orders were processed for 139 unique patients, with an average 1.7-day supply dispensed.
  • Most methadone dispenses occurred on weekends to facilitate discharge, potentially saving 310 inpatient days.

Conclusions:

  • Pharmacy-led interventions can successfully increase the utilization of essential medications for SUD.
  • Streamlined processes for IM-NTX and methadone support continuity of care and reduce hospital resource utilization.
  • Addressing logistical and systemic barriers is crucial for effective medication management in SUD treatment.