In 2015, opioid death rate in the state of North Carolina soared from 7% in 2014 to 14.9%. The opioid crisis has continued to affect our community as first responders responded to 529 opioid overdoses during 2017 alone.
In 2016, the Center for Disease Control (CDC) released Guidance for Safely Prescribing Opioids for Chronic Pain. This guideline prompted NHRMC’s family medicine residency clinic to evaluate the safe prescribing of opioids to patients with chronic pain.
Data suggests that primary care physicians are aware of naloxone yet are unsure how and when to prescribe this life-saving antidote. Ambulatory care pharmacists are in a unique position to bridge the gap of medication access and community education through their role working with primary care providers.
The NHRMC program utilizes ambulatory care pharmacists embedded at Coastal Family Medicine to establish a naloxone program for patients at high risk of opioid overdose.
Our goal was to make sure these patients received education and access to the life-saving medication naloxone.
NHRMC created an Electronic Medical Record note template to be used during pain-focused clinic visits. The template outlined risk factors and prompted the provider to co-prescribe naloxone.
After implementation, we identified that physicians had limited experience with naloxone. Physicians sought pharmacists’ assistance with prescribing and the role of naloxone for patients with chronic pain. Our ambulatory care pharmacists then expanded their role and developed a naloxone program.
The CDC guidelines promote the use of Prescribe to Prevent, so we chose this resource for standardized naloxone education. We also found that videos and handouts from websites of naloxone manufacturers were useful, and we plan to expand our education in the future. We incorporated the face-to-face education into the physician’s visit. The new program improves access to naloxone through avoidance of additional co-pays or transportation to our clinic for separate visits.
This naloxone program has changed the culture of our health system by starting the conversation of naloxone with all eligible patients on opioid treatment. Our efforts have helped educate physician providers of the importance of naloxone access, and helped in reducing the stigma associated with naloxone for both patients and providers.
Most importantly, we identified patients at risk for overdoses, educated them and provided naloxone to them.
At this start of this program, ambulatory care pharmacists identified 49 patients who had risk factors for opioid overdose per CDC criteria. From December 2016 to June 2017, ambulatory care pharmacists successfully provided overdose and naloxone education to 84% (n=41) of patients who met qualifying criteria. All patients who received education by an ambulatory care pharmacist also received a prescription for naloxone. Our pharmacists were also able to verify that of those patients who received naloxone education, 83% (n=34) could successfully obtain naloxone from their pharmacy. The remaining patients either refused the medication, or were unable to be reached by telephone. To date, no patients who received a naloxone prescription have requested a refill. Per periodic chart reviews, we are also unaware of any patient who required the use of naloxone.
The Naloxone Education Program at New Hanover Regional Medical Center earned a Silver Touchstone Award from Atrium Health, which has a services agreement with NHRMC. The Touchstone Award was one of seven earned by NHRMC in 2018.
- Elizabeth Kyle, PharmD
- Lisa Edgerton, PharmD
- Ryan Tewell, PharmD (PGY2 Ambulatory Care Pharmacy Resident 2016-2017)