Clinical Pharmacy Specialist Positive Health Clinic

Cindy Powers Magrini, PharmD, BCPS

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Naloxone Prescribing at The Positive Health ClinicCindy Powers Magrini, PharmD, BCPSClinical Pharmacy Specialist, Positive Health Clinic (PHC)

July 31, 2012

Introduction to the PHC

• Clinic offers early HIV intervention and treatment using a harm reduction model

• Funded through a federal grant under the Ryan White CARE Act of 1990

• ~750 HIV-positive patients

• 5 physicians

• 2 nurse practitioners

• 3 nurses

• 4 social workers

• 2 medical assistants

• 1 patient advocate

• 1 data analyst

• 1 grant coordinator

• 1 administrative director

• 1 pharmacist

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Cristina Elgins’s Presentation for PHC Staff• Local trends in overdose

• National trends in overdose

• Strategies for preventing opioid fatalities

• Prevention Point Pittsburgh

• Other naloxone prescribers in Pittsburgh

• Project Lazarus

• Legality of prescribing naloxone—Temple University School of Law Memo

• How to treat an overdose situation

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Naloxone Prescribed When: 1. Patient release after emergency medical care involving opioid

OD/intoxication

2. Suspected history of illicit or nonmedical opioid use

3. High-dose opioid prescription (> 50 mg of morphine equivalence/day)

4. Any methadone prescription to opioid naïve patient

Any opioid prescription and …

5. smoking/COPD/emphysema/asthma or other respiratory illness

6. renal dysfunction, hepatic disease

7. known or suspected concurrent alcohol use

8. concurrent benzodiazepine prescription

9. concurrent SSRI or TCA anti-depressant prescription5

Naloxone Prescribed When:

10. Prisoner released from custody

11. Release from opioid detoxification or mandatory abstinence program

12. Voluntary request from patient

13. Patients in methadone or buprenorphine detox/maintenance (for addiction or pain)

14. Patient may have difficulty accessing emergency medical services (distance, remoteness)

15. Other (specify): ____________________________________6

Policy and Procedure Creation

• Intranasal Naloxone Policy

• Controlled Substances Policy

• Any patient with an opioid prescription can be ordered intranasal naloxone by either a nurse or pharmacist per protocol

• Any patient who has a known history of opioid misuse will be offered a prescription for intranasal naloxone after discussion with a prescribing practitioner

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Patient Education

• Patients and family members or friends will watch the intranasal naloxone training video (produced by PPP)

• Staff will review the patient education checklist

• Patients will be given the opportunity to ask questions

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Naloxone Dispensing at PHC

• After the patient has been educated, they will leave the clinic with naloxone in hand that has been dispensed from clinic stock

• The clinic stock will be replaced by placing an order with the clinic’s contract pharmacy

• The order will be adjudicated with the patient’s insurance, if applicable

• The replacement stock will be received at the clinic next day

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Naloxone Dispensing at PHC

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Challenges and Obstacles

• Mechanism for patient education that is sustainable

• Naloxone shortage

• EHR implementation

• Prescribers– Raises uncomfortable issues for prescribers

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Questions

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