title: Development of a targeted naloxone coprescribing program in a primary care practice.
abstract: OBJECTIVE
  To develop a targeted naloxone coprescribing program in a primary care practice.
  
  
  METHODS
  Large academic family medicine practice in western North Carolina.
  
  
  METHODS
  A robust pain management program was developed at this institution in 2012 which incorporated many of the recommendations later outlined in the 2016 Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain. The only guideline-recommended initiative that was not addressed involves providing naloxone to patients on chronic opioid therapy at high risk for opioid overdose.
  
  
  METHODS
  Pharmacists embedded in this practice developed a targeted naloxone coprescribing program for patients who are on chronic opioid therapy and have doses of 50 mg or more morphine equivalents daily (MED), are taking benzodiazepines, have a history of substance use disorder, or have a history of overdose.
  
  
  RESULTS
  A retrospective chart review was conducted to determine the number of patients on chronic opioid therapy who meet the CDC guidelines for offering naloxone.
  
  
  RESULTS
  A total of 1297 patients were identified, and 709 met the criteria for chronic opioid use. Nearly one-half (n = 350; 49.4%) of these patients met the criteria for naloxone, although only 3.4% had naloxone on their medication list. Doses of 50 mg or more MED was the primary reason for needing naloxone (n = 216; 61%) with concomitant benzodiazepine use as the second most likely reason (n = 130; 37.1%). For patients taking 50 mg or more MED, 37.5% were also on a benzodiazepine and 4.1% also had a history of substance use disorder.
  
  
  CONCLUSIONS
  Pharmacists embedded in a primary care practice are well poised to develop a targeted naloxone coprescribing program to increase patients' access to naloxone.
authors.forename: Courtenay Gilmore
authors.initials: CG
authors.lastname: Wilson
authors.forename: Franklin
authors.initials: F
authors.lastname: Rodriguez
authors.forename: Anne C
authors.initials: AC
authors.lastname: Carrington
authors.forename: E Blake
authors.initials: EB
authors.lastname: Fagan
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage; D059350:Chronic Pain / Q000188:drug therapy; D062787:Drug Overdose / Q000188:drug therapy*; D006297:Health Services Accessibility; D006801:Humans; D009270:Naloxone / Q000008:administration & dosage* / Q000600:supply & distribution; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000600:supply & distribution; D009657:North Carolina; D009293:Opioid-Related Disorders / Q000150:complications; D059408:Pain Management / Q000379:methods; D010595:Pharmacists / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D016730:Program Development; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D001569:Benzodiazepines; D009270:Naloxone