Naloxone co-prescribing for emergency medicine and trauma patients at high risk for opioid overdose

Introduction: Overdose deaths in Milwaukee County have increased 117% from 2014 to 2020, and the opioid overdose fatality rate is double compared to the state. Naloxone is a lifesaving antidote that can reduce overdose deaths when readily available to patients taking opioids. To promote naloxone co-prescribing, our health system implemented a naloxone best practice alert (BPA). This study was designed to compare naloxone co-prescribing before and after the implementation of the naloxone co-prescribing BPA. Methods: A quasi-experimental evaluation comparing naloxone prescribing 6 months before (Jul-Dec 2021) and after (Jan-Jun 2022) implementation of a naloxone co-prescribing BPA was conducted at a large health system comprised of 11 hospitals and more than 45 clinics. Upon signing discharge prescriptions within the electronic medical record (EMR), the BPA notified providers when a patient is at high-risk for opioid overdose and encouraged mitigation strategies be discussed with the patient, including naloxone co-prescribing. High-risk patients were defined as those receiving opioid co-prescribed with benzodiazepine, opioid prescribed at a dose of at least 50 morphine milligram equivalents per day, or with opioid overdose history. No other naloxone-related interventions went live during this time. The dual primary outcomes are the number of naloxone prescriptions written by trauma and emergency medicine (EM) providers. A Chi-Square Test was used to compare the pre- and post-groups. Results: During the study period, the trauma service generated 904 and 878 opioid prescriptions in the pre- and post-groups, respectively, of which 72 and 67 were high-risk scenarios, respectively. The rate of naloxone co-prescribing to high-risk patients increased from 1.4% (n=1) to 50.7% (n=34), p < 0.001. During the study period, the EM service generated 3677 and 3142 opioid prescriptions in the pre- and post-groups, respectively, of which 79 and 66 were high-risk scenarios, respectively. The rate of naloxone co-prescribing to high-risk patients increased from 20.2% (n=16) to 80.3% (n=53), p < 0.001. Conclusions: Implementing a naloxone co-prescribing BPA into the EMR at the time of providers signing discharge prescriptions substantially increases naloxone co-prescribing to patients at high-risk for opioid overdose.