Implementation of Naloxone Prescribing, Overdose Quality Improvement Program

An educational discussion about opioid safety and prescription of naloxone was well received by clinicians and patients and increased naloxone prescribing rates, according to the results of a study published in the Journal of Pain and Symptom Management.

This study was designed to evaluate feasibility and acceptability of a standard naloxone education and prescribing policy for new opioid recipients. Between August and September 2020, baseline naloxone prescribing practices for all patients with active cancer were collected at a palliative care cancer center in the United States. After implementing a policy that required new opioid prescriptions to be accompanied with an order for naloxone, prescribing practices between November 2021 and January 2021 were assessed. Naloxone prescribing rates were compared between the 2 time periods, and clinician and patient opinions about naloxone education were assessed using surveys.

The baseline population consisted of 64 patients, among whom 44 received an opioid prescription and only 2 were prescribed naloxone. After implementation of the naloxone policy, 63 of the 95 patients received opioids, 42 of whom received naloxone (P <.001).

A total of 25 clinicians completed the naloxone survey. Most clinicians (92%) said that naloxone education and prescribing took 5 minutes or less to complete and that discussing naloxone had a neutral (60%) or positive (40%) impact on their patient encounter.

A total of 31 patients who received naloxone completed a survey. Most (81%) said they did not have worries about opioid use, and 68% said they felt safer with naloxone. The naloxone discussion was rated as a neutral experience by 58% and as a positive experience by 39%.

Most naloxone prescriptions (88%) were distributed by pharmacies. Most patients (67%) paid less than $10 for their prescription.

One patient incorrectly used naloxone, which resulted in withdrawal symptoms without need for emergency intervention or hospitalization. This error was thought to be due to a miscommunication with the patient’s translator.

The limitations of this pilot study included the small sample size and the single-center design.

These data indicate that naloxone education and prescribing can be accomplished in less than 5 minutes without a negative impact on patient experience. The study authors comment, “[A]ll clinicians who care for patients with cancer should have a fundamental understanding of how to counsel patients on the risk of opioid overdose, for them and their loved ones, and how to responsibly and effectively prescribe lifesaving naloxone.” Additional study is needed to assess whether increasing naloxone distribution decreases overdose rates.