6/13/2019 Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Pharmacy-Initiated Naloxone Co-Prescribing Service Co-Prescribing Service Co-Prescribing Service Co-Prescribing Service Tyle Tyle ler Chia, ler Chia, r Chia, P r Chia, P Pharm.D Pharm.D arm.D., MP arm.D., MP MPH MPH LT Miaka Huynh, PharmD LT Miaka Huynh, PharmD Pharmacist, Lawton Indian Hospital Pharmacist, Lawton Indian Hospital Mentors: James F James F Foster Foster er, P er, P Phar Phar arm.D., arm.D., m.D., BCPS m.D., BCPS PGY-1 Pharmacy Resident PGY-1 Pharmacy Resident Acting Resident Program Director Acting Resident Program Director Lawton Indian Hospital Lawton Indian Hospital Jessica Jessica Je Je ca S ca S Stei Stei einert, einert, rt, Pharm. rt, Pharm. Pharm.D. Pharm.D. D., MHA D., MHA MHA, BCGP MHA, BCGP BCGP BCGP Acting Chief Pharmacist, Lawton Indian Hospital Acting Chief Pharmacist, Lawton Indian Hospital Disclosure Disclosure Disclosure Disclosure Under guidelines established by the Accreditation Council for Under guidelines established by the Accreditation Council for Pharmacy Education, disclosure must be made regarding Pharmacy Education, disclosure must be made regarding financial relationships with commercial interests within the financial relationships with commercial interests within the last 12 months. last 12 months. Miaka Huynh, Tyler Chia, James Foster, and Jessica Steinert Miaka Huynh, Tyler Chia, James Foster, and Jessica Steinert have no relevant financial relationships or affiliations with have no relevant financial relationships or affiliations with commercial interests to disclose. commercial interests to disclose. 2 1
6/13/2019 Learning Objectives Learning Objectives Learning Objectives Learning Objectives At the completion of this activity, pharmacists will be able to: At the completion of this activity, pharmacists will be able to: Describe the number of drug overdoses in the state of Oklahoma Describe the number of drug overdoses in the state of Oklahoma Indicate the need for a pharmacy-initiated naloxone co- Indicate the need for a pharmacy-initiated naloxone co- prescribing service prescribing service Outline the naloxone consultation process at a federal IHS site Outline the naloxone consultation process at a federal IHS site At the completion of this activity, pharmacy technicians will be able to: Indicate the need for a pharmacy-initiated naloxone co-prescribing 3 service Pre-Assessment Question #1 Pre-Assessment Question #1 Pre-Assessment Question #1 Pre-Assessment Question #1 In 2017, how many overdose deaths involving opioids occurred in Oklahoma? In 2017, how many overdose deaths involving opioids occurred in Oklahoma? A. Less than 200 A. Less than 200 B. 200 – 300 B. 200 – 300 C. 301 – 400 C. 301 – 400 D. More than 400 D. More than 400 4 2
6/13/2019 Pre-Assessment Question #2 Pre-Assessment Question #2 Pre-Assessment Question #2 Pre-Assessment Question #2 Why should pharmacy initiate a naloxone co-prescribing service? Why should pharmacy initiate a naloxone co-prescribing service? A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and A. House Bill 2039 (2017) allows pharmacists the authority to prescribe and dispense naloxone dispense naloxone B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows B. Title 535 - Oklahoma State Board of Pharmacy, chapter 10, subchapter 9, allows pharmacist to “prescribe and dispense Naloxone without a protocol or prescription pharmacist to “prescribe and dispense Naloxone without a protocol or prescription to any person at risk of experiencing an opioid-related drug overdose” to any person at risk of experiencing an opioid-related drug overdose” C. As of 2018, the Department of Mental Health and Substance Abuse Services has C. As of 2018, the Department of Mental Health and Substance Abuse Services has promoted an initiative called Prescription for Change to combat the opioid promoted an initiative called Prescription for Change to combat the opioid epidemic in Oklahoma epidemic in Oklahoma 5 D. All of the above D. All of the above Pre-Assessment Question #3 Pre-Assessment Question #3 Pre-Assessment Question #3 Pre-Assessment Question #3 What is the correct naloxone consultation process at the Lawton Indian Hospital? What is the correct naloxone consultation process at the Lawton Indian Hospital? A. Provider enters consult, pharmacist educates patient, pharmacist dispenses A. Provider enters consult, pharmacist educates patient, pharmacist dispenses naloxone naloxone B. Provider enters consult, patient signs consent form, pharmacist dispenses B. Provider enters consult, patient signs consent form, pharmacist dispenses naloxone naloxone C. Provider/pharmacist enters consult, pharmacist educates patient, patient C. Provider/pharmacist enters consult, pharmacist educates patient, patient signs consent form, pharmacist dispenses naloxone signs consent form, pharmacist dispenses naloxone D. Provider/pharmacist enters consult, pharmacist educates patient, pharmacist D. Provider/pharmacist enters consult, pharmacist educates patient, pharmacist dispenses naloxone dispenses naloxone 6 3
6/13/2019 Oklahoma Data Oklahoma Data Oklahoma Data Oklahoma Data Ok.gov. Oklahoma Special Emphasis Report: Drug Overdose Deaths,1999-2013. 2013 2013 Oklahoma Data Oklahoma Data Oklahoma Data Oklahoma Data Total drug overdose deaths = 777 Total drug overdose deaths = 777 477 from opioids pain relievers (61%) 477 from opioids pain relievers (61%) 8 4
6/13/2019 Drugabuse.org. Oklahoma Opioid Summary. 2017 2017 Oklahoma Data Oklahoma Data Oklahoma Data Oklahoma Data Total drug overdose deaths = 388 Total drug overdose deaths = 388 251 from prescription opioids (65%) 251 from prescription opioids (65%) 9 Why Pharmacy-Initiated? Why Pharmacy-Initiated? Why Pharmacy-Initiated? Why Pharmacy-Initiated? 5
6/13/2019 House Bill House Bill House Bill House Bill 2039 2039 2039 2039 11 Oklegislature.gov. Bill Information for HB 2039. House Bill House Bill House Bill House Bill 2039 2039 2039 2039 12 Oklegislature.gov. Bill Information for HB 2039. 6
6/13/2019 Elaws.us. Oklahoma Administrative Code. Title 535, Chapter 10, Subchapter 9 Title 535, Chapter 10, Subchapter 9 tle 535, Chapter 10, Subchapter 9 tle 535, Chapter 10, Subchapter 9 13 Okimready.org. Opioid Overdose. Okimready.org 14 7
6/13/2019 15 Naloxone Co-Prescribing Service Naloxone Co-Prescribing Service Naloxone Co-Prescribing Service Naloxone Co-Prescribing Service 8
6/13/2019 Objectives Objectives Objectives Objectives Primary objective: Primary objective: Expand a pharmacy-initiated program to identify patients at high Expand a pharmacy-initiated program to identify patients at high risk for opioid overdose and provide them with naloxone for risk for opioid overdose and provide them with naloxone for overdose reversal overdose reversal Secondary objective: Secondary objective: Follow up with patients who received naloxone to assess their Follow up with patients who received naloxone to assess their knowledge of naloxone’s indication, administration technique, and knowledge of naloxone’s indication, administration technique, and usage history usage history 17 Inclusion Criteria Inclusion Criteria Inclusion Criteria Inclusion Criteria Inclusion criteria: Inclusion criteria: Patients ≥ 18 years old and at high risk for opioid overdose: Patients ≥ 18 years old and at high risk for opioid overdose: Opioid dose ≥ 50 Morphine Milligram Equivalents (MME) per day Opioid dose ≥ 50 Morphine Milligram Equivalents (MME) per day Concurrent use of a benzodiazepine Concurrent use of a benzodiazepine Current poly-opioid use Current poly-opioid use Patients ≥ 65 years old with prescribed long term duration of opioid Patients ≥ 65 years old with prescribed long term duration of opioid treatment ( ≥ 3 months) treatment ( ≥ 3 months) 18 9
6/13/2019 Exclusion Criteria Exclusion Criteria Exclusion Criteria Exclusion Criteria Exclusion criteria: Exclusion criteria: Patients who are not prescribed opioid medications Patients who are not prescribed opioid medications Patients taking opioids for acute pain ( < 30 days) Patients taking opioids for acute pain ( < 30 days) 19 Naloxone Co-Prescribing Process Naloxone Co-Prescribing Process Naloxone Co-Prescribing Process Naloxone Co-Prescribing Process Identify high risk patient Consult entered by provider and/or pharmacist Educate patient and obtain informed consent Dispense naloxone kit Follow-up via telephone 20 Acs.org. Molecule of the Week Archive – Naloxone. 10
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