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

Substance use disorders (SUD) affect 17% of the United States population, and over 25% of U.S. hospitalizations are related to drug and alcohol use. Despite strong evidence and guideline recommendations, medications for SUD remain underutilized due to social stigma and institutional, legislative, and financial barriers. To address underutilization in one academic hospital, pharmacy-led processes were developed for hospital-administered intramuscular naltrexone (IM-NTX) and hospital-dispensed methadone at discharge. Workflows relied on pharmacy leadership and clinical pharmacist champions. Key steps included provider ordering, pharmacist verification, inpatient preparation, administration, chain of custody, and patient education. During the data collection period from December 2022 through March 2025, 323 orders were placed for IM-NTX and verified 304 times for 248 unique patients, primarily for alcohol use disorder. Of the verified orders, 267 (88%) doses were prepared and 225 (74%) administered. Between April 2023 and May 2025, hospital-dispensed methadone was ordered 231 times for 139 unique patients during 175 hospital encounters. Patients received an average 1.7 days' supply per encounter, with a mean daily dose of 77 mg (range 10-310 mg). Most dispenses (64%) occurred on Fridays and Saturdays to support weekend discharges when opioid treatment programs are typically closed in Colorado. It is estimated that this process saved 310 inpatient days over 26 months.