Pharmacist-Led Initiative to Increase Naloxone Prescribing for Patients on High-Dose Opioids in a General Internal Medicine Clinic

Abstract Introduction: Opioid overdose is a pressing public health concern in the United States. In 2022, prescription opioids were involved in 15% of all opioid deaths.1 Despite CDC recommendations for prescribing naloxone to high-risk patients, primary care physicians prescribe only 1.5 naloxone prescriptions per 100 prescriptions of high-dose opioids.2,3 Strategies are needed for healthcare institutions to expand naloxone access and mitigate opioid-related harm. This pilot study assesses the impact of a pharmacist-led quality improvement patient outreach initiative on increasing naloxone prescribing for adult patients taking ≥ 50 MME per day of prescription opioids as recommended by current CDC guidelines. Methods: This pilot study was a non-randomized quality improvement initiative involving ambulatory patients ≥ 18 years of age in a General Internal Medicine (GIM) Clinic prescribed ≥ 50 MME/day of opioids for chronic pain from August to November 2023. Patients without a confirmed dispense of naloxone in the past 12 months and meeting other eligibility criteria were contacted, by letter and telephone, to provide naloxone education. If accepted, a prescription for naloxone was sent to the patient’s pharmacy. Results: The number of patients with prescriptions for both naloxone and ≥ 50 MME/day of an opioid increased from 24 patients (56%) to 37 patients (86%) after the pharmacist led patient outreach intervention, a 54% increase. Conclusions: Pharmacist-led patient outreach increased the concomitant prescribing of naloxone for patients taking high dose opioids. Opportunities remain for identification of patients in need of naloxone education and prescriptions.