3 Opioid Overdose Reversal Facts Health-System Pharmacists Should Know

JUNE 14, 2016
Meghan Ross, Senior Associate Editor
Considering that there has been a 400% increase in opioid overdoses in the last decade, health-system pharmacists can expect to see naloxone play an increasingly important role in their practice.

At a recent pharmacy conference, only a handful of pharmacists indicated that they or the physicians in their health system prescribed naloxone; meanwhile, nearly 10% of the US population aged 12 years and older has a substance abuse or dependence problem and may benefit from having access to naloxone.

Juliana Zschoche, PharmD, an emergency medicine clinical pharmacy specialist at Johns Hopkins Hospital, told Pharmacy Times that the role of the health-system pharmacist in managing opioids is similar to the role he or she plays with other medication classes.

“We should be assessing whether it’s appropriate, what the dose is, and what the side effects are,” Dr. Zschoche said. “We want to ensure that patients are using it as safely as possible [and] getting the most efficacy at the lowest dose possible.”

Health-system pharmacists should also assess whether opioids will be used in the short term or in the long-term, and nonopioid analgesic options should be considered. Plus, pharmacists can work with prescribers to think about the quantity of opioids needed for a prescription.

In addition, Dr. Zschoche noted that pharmacists can educate prescribers that there isn’t a 1:1 conversion when switching between different opioids, so providers can ensure patients are getting the right dose.

Prescription drug monitoring programs are also critical to ensuring that patients aren’t abusing drugs, as well.

Suzanne A. Nesbit, PharmD, BCPS, CPE, a clinical pharmacy specialist in pain and palliative care from Johns Hopkins Hospital, added that there has been a concerning spike in fentanyl use in the last few years, and unintentional fatal overdoses are on the rise. Some patients with substance disorders who are used to a certain amount of heroin each day may receive a dose that’s laced with fentanyl, and then their usual dose becomes lethal, Dr. Nesbit noted.

Although the use of naloxone as an opioid overdose antidote is becoming more prevalent, it isn’t new. For example, Dr. Nesbit mentioned the 2008 community coalition, Project Lazarus, which is a public health model that revolves around drug overdose prevention, naloxone use, and community building and monitoring.

There are still some challenges and opportunities for naloxone education, so here are 3 things pharmacists should keep in mind when dealing with the opioid overdose antidote.