Clinical pharmacy initiative to increase naloxone prescribing in patients with opioid use disorder

Introduction: The national opioid epidemic has become a key focus of various health agencies. Recent data suggest increases in overdose deaths, primarily driven by synthetic opioids, during the 2019 novel coronavirus disease pandemic. A leading strategy in mitigating risk from the opioid public health crisis, including opioid use disorder (OUD), is via increased promotion and access to the lifesaving, opioid overdose-reversing medication, naloxone. Pharmacists have been recognized as integral in addressing this emergency;however, literature evaluating outcomes from multifaceted clinical pharmacy specialist (CPS) interventions and involvement are lacking. Research Question or Hypothesis: A quality improvement project was undertaken with the expectation that CPS involvement would result in increased naloxone prescribing proportions (quantity of OUD patients with an active prescription for naloxone within the past year divided by the quantity of patients with OUD), improved patient access to care, and increased clinical interventions. Study Design: A before and after evaluation was conducted. Methods: CPSs spearheaded a variety of interventions to increase naloxone prescribing in patients with OUD, including naloxone informational letters, focused education with prescribers, review of clinical dashboards identifying OUD patients indicated to receive naloxone, CPS naloxone prescribing, and automated naloxone medication orders integrated into electronic health record progress note templates. Naloxone prescribing proportions were compared before and after implementation of these interventions. Other measures evaluated were number of encounters, patients and clinical interventions completed by the CPSs. The evaluation period for both groups was three months. Prescribing proportions were compared through statistical analysis with chi-squared for nominal data. Results: Naloxone prescribing proportions increased from 21.9% to 56.0% (p<0.01). Number of encounters, patients and clinical interventions completed increased by 45%, 74%, and 36%, respectively. Conclusion: The significant increase in naloxone prescribing proportions and numerically increased encounters, patients, and clinical interventions suggest the value of CPS involvement in targeting the opioid epidemic.