Standard Naloxone Prescribing for Palliative Care Cancer Patients on Opioid Therapy: A Single-Site Quality Improvement Pilot to Assess Attitudes and Access

• Published in: Journal of pain and symptom management 2023-04, Vol.65 (4), p.e309-e314
• Main Authors: Afezolli, Debora, Flemig, David, Easton, Eve, Austin, Vanessa, Scarborough, Bethann, Smith, Cardinale B.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; cancer pain; Drug Overdose - drug therapy; Humans; Naloxone; Naloxone - therapeutic use; Narcotic Antagonists - therapeutic use; Neoplasms - drug therapy; opioid overdose prevention; opioid risk assessment; Opioid-Related Disorders - drug therapy; Palliative Care; Quality Improvement; safe opioid prescribing; supportive oncology
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.12.014

Limited data exist on when to offer naloxone to cancer patients on opioid therapy. We assessed patient and clinician attitudes on naloxone education (done via surveys at initial and follow up visits) and prescribing rates (via chart reviews) at a single ambulatory palliative care practice. Pharmacy records assessed naloxone dispense rates. During a three-month period, all new patients receiving opioid therapy were offered naloxone. Standardized educational materials on opioid safety and naloxone use were created and shared by clinical team. Naloxone prescribing rates increased from 5% to 66%. 92% (n = 23) of clinicians reported education/prescribing took ≤ five minutes, and 100% reported either a positive or neutral impact on the encounter. A total of 81% (n = 25) of patients reported no increased worry about opioid use, 68% (n = 21) felt safer with naloxone, and 97% rated the encounter as neutral or positive. 88% (n = 37) of prescriptions were dispensed and 67% of patients (n = 16) paid