Evaluation of a pharmacist-led intervention on naloxone co-prescribing in patients receiving chronic opioid therapy

Introduction Although both the 2016 Centers for Disease Control and Prevention (CDC) guidelines and the 2020 Food and Drug Administration (FDA) safety announcement recommend naloxone co-prescribing to patients receiving long-term opioid therapy (LTOT) for non-cancer pain, the rate of naloxone co-prescription in this population remains low. Objectives The primary objective of this project was to determine whether a pharmacist intervention would lead to increased rates of naloxone co-prescribing among providers. Methods This was a before-and-after interventional study to evaluate changes in naloxone co-prescribing rates in response to clinical pharmacist recommendation of naloxone for LTOT patients to providers. The primary end point was rate of naloxone co-prescription after pharmacist intervention. Providers of LTOT patients were emailed patient-specific recommendations. Additional end points included calculation of the naloxone possession rate among patients and identification of patient-specific predictors for not having naloxone co-prescribed at baseline. Results A total of 152 patients met inclusion criteria throughout the intervention period. Out of the 152 patients who were eligible for naloxone, 90 (59.2%) were prescribed naloxone before the intervention and 131 (86.2%) were prescribed naloxone after the pharmacist provided interventions. This increase in naloxone prescription (27%) was statistically significant (P < .001). Our results also showed that LTOT patients who were prescribed opioids by adult primary care providers were at risk for lack of naloxone co-prescribing at baseline (adjusted odds ratio [aOR] 3.66, P = .013) as compared with patients taking opioids prescribed by a pain management provider. The overall possession rate among patients with naloxone co-prescribed by the end of the intervention period was 56.4% (74/131 patients). Conclusion A pharmacist-led intervention was found to increase the naloxone co-prescribing rate for LTOT patients. However, co-prescribing naloxone does not guarantee patient possession; only 56.4% of patients with a naloxone prescription appeared to have naloxone at home. Future studies should explore ways to increase naloxone possession rates.