2025 Southeastern Residency Conference

TITLE: Impact of clinical pharmacy team intervention on naloxone fills in patients on chronic opioid therapy 
AUTHORS: Rosy S. Sijapati, Erin R. Himes, Stephanie Hale
BACKGROUND: Opioids are highly effective for pain management but carry risks of addiction, overdose, and life-threatening respiratory depression. Naloxone, an opioid antagonist, can quickly reverse opioid overdoses by blocking opioid receptors in the brain. Despite its effectiveness, naloxone remains underutilized due to barriers such as stigma, lack of awareness, and access issues. Kaiser Permanente created the Interregional Pharmacy Opioid Use Improvement (OUI) Group to support safe opioid prescribing and increase appropriate naloxone prescribing. The purpose of this study was to evaluate the impact of clinical pharmacy team interventions on naloxone fills in patients on chronic opioid therapy of ≥ 50 morphine milligram equivalents (MME)/day.
METHODS: This was a retrospective, observational, IRB-exempt cohort study conducted within an integrated healthcare delivery system. Inclusion criteria included Kaiser Permanente Georgia (KPGA) members who are 18 years and older and filling chronic opioid therapy of ≥ 50 MME averaged over the last 90 days. Exclusion criteria included patients with a cancer diagnosis or enrolled in hospice care. The primary objective was to compare the number of patients meeting inclusion criteria who filled a naloxone prescription within the last 24 months as of March 31, 2023 versus as of December 31, 2023. The secondary outcome was to compare the naloxone fill rates based on intervention type. Data reported by the OUI Group from April 1, 2023, to September 30, 2023 was used. Descriptive statistics was used to determine the similarities in patient characteristics and the Chi-squared test was used to determine the statistical significance of categorial variables.
RESULTS: A total of 496 patients were included in this study. The mean patient age was 60 years, and the majority were Caucasian female (55%). As of March 31, 2023, 399 patients were eligible for a naloxone prescription compared to 356 patients eligible as of December 31, 2023. There were 122 naloxone prescriptions (30.6%) filled as of March 31, 2023 and 241 naloxone prescriptions (67.7%) filled as of December 31, 2023. This represents an absolute increase of 119 naloxone prescriptions (37.1%) between the pre- and post-intervention time periods (P < 0.0001). Clinical Pharmacy Specialists (CPSs) contacted 31 patients via telephone outreach, all of whom (100%) filled their naloxone prescriptions. Pharmacy technicians contacted 106 patients via telephone outreach, resulting in 75 naloxone prescriptions filled (70.8%). An additional 56 patients received outreach via secure message only, with 42 naloxone prescriptions filled (75%). Among patients not directly reached, 37 received voicemails, and 15 of those (40.5%) filled their naloxone prescriptions. Additionally, 100 patients were successfully reached and spoken to directly, and 91 naloxone prescriptions were filled (91%).
CONCLUSION: The rate of naloxone prescription fills increased significantly when the clinical pharmacy team intervened. The findings of this study suggest that direct telephone contact, especially by clinical pharmacists, had the highest success rate for encouraging patients to fill their naloxone prescriptions. Voicemails had a significantly lower fill rate, highlighting the importance of direct interaction in improving patient outcomes.