Pharmacist-initiated naloxone discharge prescribing for high-risk hospitalized internal medicine patients

Michaela Elise Wermers; Ashley Weisensel Sturm; Sarah Aileen Mancini; Breann Mary Hogan

doi:10.5055/jom.0887

Authors

Michaela Elise Wermers, PharmD https://orcid.org/0009-0004-8505-0214
Ashley Weisensel Sturm, PharmD
Sarah Aileen Mancini, PharmD
Breann Mary Hogan, PharmD

DOI:

https://doi.org/10.5055/jom.0887

Keywords:

naloxone, overdose, pharmacist, opioids

Abstract

Pharmacists nationwide may play a critical role in expanding naloxone access after several states enacted legislation to allow pharmacist prescribing of opioid antagonists. This created a unique opportunity for inpatient pharmacists to participate in combating the opioid epidemic by prescribing naloxone at hospital discharge. A multifaceted intervention was developed to identify and educate hospitalized patients eligible for naloxone prescribing. After implementation, 22 of 40 eligible patients (55 percent) were prescribed naloxone by inpatient pharmacists during the 3-month study period. With this pharmacist-driven intervention, there was an 848 percent increase in the number of hospitalized chronic opioid patients with naloxone prescriptions on discharge.

Author Biographies

Michaela Elise Wermers, PharmD

Internal Medicine Clinical Pharmacist, Mayo Clinic St. Mary’s Hospital, Rochester, Minnesota

Ashley Weisensel Sturm, PharmD

Internal Medicine Clinical Pharmacist, Mayo Clinic St. Mary’s Hospital, Rochester, Minnesota

Sarah Aileen Mancini, PharmD

Internal Medicine Clinical Pharmacist, Mayo Clinic St. Mary’s Hospital, Rochester, Minnesota

Breann Mary Hogan, PharmD

Internal Medicine Clinical Pharmacist, Mayo Clinic St. Mary’s Hospital, Rochester, Minnesota

References

US Department of Health and Human Services: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. 2022. National Survey and Drug Use and Health. 2022. Available at https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nnrbriefing-slides.pdf. Accessed August 12, 2024.

Spencer M, Garnett M, Miniño A: Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief, No. 491. National Center for Health Statistics, 2024. DOI: https://doi.org/10.15620/cdc:135849

Zedler B, Xie L, Wang L, et al.: Risk factors for serious prescription opioid-related toxicity or overdose among veterans health administration patients. Pain Med. 2014; 15(11): 1911-1929. DOI: https://doi.org/10.1111/pme.12480

Bohnert AS, Valenstein M, Bair MJ, et al.: Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011; 305(13): 1315-1321. DOI: https://doi.org/10.1001/jama.2011.370

Dunn KM, Saunders KW, Rutter CM, et al.: Opioid prescriptions for chronic pain and overdose: A cohort study. Ann Intern Med. 2010; 152(2): 85-92. DOI: https://doi.org/10.7326/0003-4819-152-2-201001190-00006

Guy GP, Haegerich TM, Evans ME, et al.: Vital signs: Pharmacy-based naloxone dispensing—United States, 2012–2018. MMWR Morb Mortal Wkly Rep. 2022; 71: 679-686. DOI: 10.15585/mmwr.mm6831e1. DOI: https://doi.org/10.15585/mmwr.mm6831e1

Xu J, Mukherjee S: State laws that authorize pharmacists to prescribe naloxone are associated with increased naloxone dispensing in retail pharmacies. Drug Alcohol Depend. 2021; 1(227): 1-7. DOI: 10.15585/mmwr.rr7103a1. DOI: https://doi.org/10.1016/j.drugalcdep.2021.109012

Sze J, Chan T, Dalpoas S, et al.: Implementation of a pharmacist-led, multidisciplinary naloxone patient education program at an academic medical center. J Pharm Pract. 2022; 36(5): 1201-1210. DOI: https://doi.org/10.1177/08971900221094268

Prach A, Clancy C, LeBlanc M, et al.: Implementation and evaluation of an inpatient naloxone program in a community teaching hospital. Res Soc Adm Pharm. 2019; 15(8): 1037-1042. DOI: https://doi.org/10.1016/j.sapharm.2018.10.004

Opiate Antagonist Protocol, § Sec. 151.37.13: MN statutes. Practice of Pharmacy, 2022. Available at https://www.revisor.mn.gov/statutes/cite/151.37#:~:text=%28a%29%20A%20licensed%20practitioner%20in%20the%20course%20of,the%20person%27s%20practice%20as%20defined%20in%20Minnesota%20Statutes. Accessed August 12, 2024.

Centers for Disease Control and Prevention: Stop Overdose: An Executive Summary. Atlanta, GA: National Center for Injury Prevention and Control, Division of Drug Overdose Prevention, 2022.