title: Opioid overdose education and naloxone distribution: Development of the Veterans Health Administration's national program.
abstract: OBJECTIVE
  To prevent opioid-related mortality, the Veterans Health Administration (VHA) developed a national Opioid Overdose Education and Naloxone Distribution (OEND) program.
  
  
  METHODS
  VHA's OEND program sought national implementation of OEND across all medical facilities (n = 142).
  
  
  METHODS
  This paper describes VHA's efforts to facilitate nationwide health care system-based OEND implementation, including the critical roles of VHA's national pharmacy services and academic detailing services.
  
  
  METHODS
  VHA is the first large health care system in the United States to implement OEND nationwide. Launching the national program required VHA to translate a primarily community-based public health approach to OEND into a health care system-based approach that distributed naloxone to patients with opioid use disorders as well as to patients prescribed opioid analgesics. Key innovations included developing steps to implement OEND, pharmacy developing standard naloxone rescue kits, adding those kits to the VHA National Formulary, centralizing kit distribution, developing clinical guidance for issuing naloxone kits, and supporting OEND as a focal campaign of academic detailing. Other innovations included the development of patient and provider education resources (e.g., brochures, videos, accredited training) and implementation and evaluation resources (e.g., technical assistance, clinical decision support tools).
  
  
  RESULTS
  Clinical decision support tools that leverage VHA national data are available to clinical staff with appropriate permissions. These tools allow staff and leaders to evaluate OEND implementation and provide actionable next steps to help them identify patients who could benefit from OEND.
  
  
  RESULTS
  Through fiscal year 2016, VHA dispensed 45,178 naloxone prescriptions written by 5693 prescribers to 39,328 patients who were primarily prescribed opioids or had opioid use disorder. As of February 2, 2016, there were 172 spontaneously reported opioid overdose reversals with the use of VHA naloxone prescriptions.
  
  
  CONCLUSIONS
  VHA has successfully translated community-based OEND into health care system-based OEND targeting 2 patient populations. There is a tremendous amount that can be learned from VHA's experience implementing this novel health care innovation nationwide.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Oliva
authors.forename: Melissa L D
authors.initials: MLD
authors.lastname: Christopher
authors.forename: Daina
authors.initials: D
authors.lastname: Wells
authors.forename: Mark
authors.initials: M
authors.lastname: Bounthavong
authors.forename: Michael
authors.initials: M
authors.lastname: Harvey
authors.forename: Julianne
authors.initials: J
authors.lastname: Himstreet
authors.forename: Thomas
authors.initials: T
authors.lastname: Emmendorfer
authors.forename: Michael
authors.initials: M
authors.lastname: Valentino
authors.forename: Mariano
authors.initials: M
authors.lastname: Franchi
authors.forename: Francine
authors.initials: F
authors.lastname: Goodman
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D020000:Decision Support Systems, Clinical; D062787:Drug Overdose / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage* / Q000600:supply & distribution; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000600:supply & distribution; D009293:Opioid-Related Disorders / Q000150:complications*; D010353:Patient Education as Topic / Q000379:methods; D010593:Pharmaceutical Services / Q000458:organization & administration; D016730:Program Development; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone