Opioid overdose prevention through pharmacy-based naloxone prescription program: Innovations in health care delivery

ABSTRACT

Background: Given that opioid misuse/abuse and opioid overdose have reached epidemic proportions in the United States, expansion of naloxone access programs are desperately needed. The objective of this study was to describe emerging trends in naloxone rescue kit (NRK) prescription patterns by pharmacists in New Mexico as an example of a unique health care delivery system. Methods: The study presents cross-sectional analysis of the data on NRK prescriptions by pharmacists who received naloxone pharmacist prescriptive authority certification since 2013. Data were obtained from the Prevention of Opioid Overdose by New Mexico Pharmacists (POINt-Rx) Registry, maintained by the University of New Mexico and the New Mexico Pharmacists Association. Results: Since 2013, 133 NRKs prescribed by pharmacists have been reported to the POINt-Rx Registry. The mean age of the patients was 41.5 ± 12.0 years (range: 19–67 years), and 60.2% were female participants. Only 11.3% of the prescriptions were from pharmacists practicing in rural/mixed urban-rural areas. The majority of NRKs (89.5%) were first-time prescriptions. The most common reason for a NRK prescription was patient's request (56.4%), followed by a pharmacist's prescription of NRK due to high dose of prescription opioids (28.6%) and history of opioid misuse/abuse (15.0%). In addition to opioids, other frequently reported substances included alcohol (9.2%) and benzodiazepines (10.8%). More than a third of patients (38.5%) reported polysubstance use in the previous 72 hours. Conclusions: These results indicate that patients at risk of opioid overdose might feel comfortable soliciting NRKs from a pharmacist. Participation of pharmacists in rural areas in the naloxone prescriptive authority highlight the opportunity for this novel health care delivery model in underserved areas; however, the program is clearly underutilized in these areas. Such a model can provide expanded patient access in community practices, whereas systematic efforts for uptake of the program by policy makers, communities, and pharmacists continue to be needed nationwide.

KEYWORDS:

• Community pharmacy
• delivery of health care
• naloxone
• opioids

Acknowledgments

We would like to thank Dr. Mark Holdsworth and Ms. Laura Garrison for critical review of the manuscript. We are also in debt to Jeanne Block, RN, for her assistance with developing and conducting training sessions with pharmacists. The authors declare that they have no conflicts of interest.

Author contributions

All authors were involved in interpretation of the results, drafting or critical revision of the manuscript for important intellectual content, and approval of the final version. In addition, Dr. Bachyrycz and Mr. Tinker were responsible for the design of the project, acquisition of the data, obtaining funding, and administrative and technical support. Mr. Shrestha was responsible for acquisition and statistical analysis of the data. Dr. Bleske was responsible for the interpretation of the data, statistical analysis, and administrative and technical support for the project. Dr. Bakhireva was responsible for the design of the project, acquisition and analysis of the data, obtaining funding, supervision of research staff, and obtaining institutional review board (IRB) approval.

Funding

This project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) through grant 8UL1TR000041, the University of New Mexico (UNM) College of Pharmacy, and the New Mexico Pharmacists Association. Dr. Bakhireva's effort is partially supported by the NIH National Institute on Alcohol Abuse and Alcoholism grants R01 AA021771 and R15 AA022242. The POINt-Rx Registry is maintained by the NMPhA and UNM College of Pharmacy using the UNM CTSC REDCap platform. All funding organizations had no direct input into the design and conduct of the study, analysis, interpretation of the data, review or approval of the manuscript, and decision to submit the manuscript for publication.