SRF026: Exploration of Interventions to Increase Naloxone Prescribing in a Community Health Center

Claire Fletcher, MD


Context: From 1999 to 2018, over 232,000 people in the United States died of overdose from prescription pain medication. Overdoses due to prescription opioids were 4 times higher in 2018 than in 1999. Many patients on chronic opioids have additional risk factors for opioid-induced respiratory depression (OIRD) and overdose (OD), including substance use disorder (SUD), use of other CNS depressants, COPD, heart failure, or obstructive sleep apnea (OSA). Despite this, fewer than 2% of opioid-dependent patients received prescriptions for naloxone from their prescriber in 2018. With a growing number of states, including Washington, requiring co-prescription of naloxone with high-dose and chronic opioids, it is necessary to identify strategies to increase naloxone prescription in order to avoid penalization or litigation. Objective: The researcher’s objective with this study was to determine whether naloxone co-prescription in a Washington state community health center (CHC) would be increased by posting reminders in physician work spaces. Human Subjects Review: An IRB self-review was performed, and the study was exempt. Study Design: Cross-sectional longitudinal study with secondary data analysis. Dataset: 23 patients. Included in study if they had received more than 3 prescriptions for narcotics in the past 6 months. Co-morbidities (COPD, heart failure, OSA, SAD), ethnicity, co-prescription of benzodiazepines, naloxone co-prescription. Population: 21/23 white non-Hispanic patients, 2 Hispanic patients. 13/23 high-risk for OIRD. 2/23 on benzodiazepine recently. 1/23 with SUD. 2/23 got naloxone in past year. Intervention: Signs in patient rooms and hallways reminding to prescribe naloxone with opioids, and listing risk factors for OIRD. Outcome Measures: Number of co-prescriptions of naloxone with opioids before vs after intervention. Results: No naloxone scripts were written during the intervention period. Expected Outcomes: The team expected to see an increase in naloxone despite decreased clinic volume due to SARS-CoV2 outbreak.This was not observed. Other confounding factors included transition to new electronic medical records (EMR) during the intervention period. Next steps will be interviewing physicians in the CHC to identify barriers to co-prescribing naloxone, and optimizing the new EMR for naloxone prescription. Learning objectives: 1. Identify risk factors for OIRD. 2. Lack of efficacy of passive interventions at changing prescribing patterns

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Paul James 11/21/2020

Claire, Excellent work!. Thank you for presenting this at NAPCRG!

Claire Fletcher 11/21/2020

Thank you!

Jack 11/21/2020

great project thanks for sharing this with NAPCRG. such and important part of good community primary care. thanks

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