(1318) Applying a Panel Management Approach to Naloxone Distribution in a Veterans Affairs Setting

Objectives: Naloxone is an important harm reduction tool and is becoming increasingly essential to offer to individuals who may be at risk for opioid overdose, including those with opioid prescriptions, use of illicit opioids, or use of other substances that are commonly contaminated with potent opioids. Many veterans remain in a population at high risk for opioid overdose. This project was intended to identify candidates for naloxone prior to their next primary care or mental health appointment through use of a population health dashboard. This would encourage providers to discuss overdose education with the goal to increase access to naloxone for veterans, ultimately resulting in higher rates of naloxone distribution in the community.

Methods: Veterans were deemed eligible if they appeared on the Overdose Education and Naloxone Distribution (OEND) Dashboard with an indication for naloxone (based on opioid prescription risk factors or substance use disorder history) and had an appointment with mental health or primary care scheduled in the next week after time of chart review. Providers were separated into prescribers (physicians, clinical pharmacists, nurse practitioners, or physician assistants) and non-prescribers (social workers, registered nurses, or clinical psychologists). The chart review note for prescribers included instructions on how to order naloxone, and the non-prescriber note included additional detail on how to request an order of naloxone from a prescriber. All chart review notes included the recommended education regarding overdose and naloxone. The veteran’s primary care or mental health provider was alerted to the chart review note prior to the appointment including the recommendation to offer naloxone and brief guidance on providing overdose education with the intention for naloxone to be discussed and offered at the appointment. Veterans were excluded if they declined naloxone within the last 6 months, if they failed to show up for the appointment, if the appointment was cancelled for any reason, or if a covering provider handled the appointment and was not alerted to the veteran’s naloxone eligibility.

Results: During a three-month period, 55 veterans deemed eligible for naloxone were included in this data set. 21 veterans were deemed eligible for naloxone based on a substance use disorder history, and 34 veterans were eligible due to a current or recent opioid prescription. In total, 35 veterans were offered naloxone during their respective appointments, representing 64% of those identified. Of the eligible patients that were offered naloxone, 30 veterans accepted naloxone (86%) and only 5 declined for various reasons.

Conclusions: We observed a high rate of veterans accepting naloxone when offered by providers in mental health and primary care appointments. Further exploration of reasons providers did not discuss naloxone in some appointments is needed, though likely include time constraints and prioritization of other issues. More prescribers than non-prescribers were alerted to patients eligible for naloxone; however, among all prescribers and non-prescribers who were alerted, there was a similar rate of offering naloxone. This intervention demonstrates that pharmacists can increase naloxone access and reduce provider workload by proactively offering specific recommendations to providers about opioid overdose and naloxone distribution. This low barrier, low time commitment intervention from pharmacists encourages naloxone education within existing appointments by familiar providers who already have rapport with the veteran.