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DoD program focuses on opioid safety and prescribing naloxone

Airman holding Narcan, a brand of naloxone Naloxone is a temporary antidote for opioid overdose that provides short-term airway relief. The Food and Drug Administration encourages providers to prescribe naloxone alongside an opioid if patients or their families are at risk for potential overdose. (Photo by Senior Airman Amber Mullen)

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For any patient who suffers from an opioid overdose, naloxone represents the best shot at reversing the symptoms long enough to receive medical attention. Naloxone provides a temporary antidote for opioid overdose as it gives short-term airway relief. The Food and Drug Administration encourages providers to prescribe naloxone alongside an opioid if patients or their families are at risk for potential overdose. However, naloxone prescriptions carry a stigma due to misconceptions about the drug’s intent.

Last year, representatives from the Defense Health Agency, Uniformed Services University of the Health Sciences, and the Defense and Veterans Center for Integrative Pain Management established the Opioid Overdose Education and Naloxone Distribution Program, or OEND. The program was created as a way to reduce the stigma of naloxone as a drug strictly for patients struggling with opioid addiction.

OEND promotes education throughout the Military Health System on naloxone’s life-saving properties. Based on the Department of Veteran Affairs program of the same name, OEND’s goal is to increase co-prescribing of naloxone to reduce opioid-related overdoses and death.

Patients can be at risk for opioid overdose for factors not related to opioid abuse. Conflicts with other medications, underlying medical conditions like lung problems and sleep apnea, and even taking opioids after not taking them for a long time can increase risk of opioid overdose or death. OEND provides information about safe opioid use and naloxone on its website, through social media campaigns, and by train-the-trainer programs for providers. These resources and tools all contribute to what Army Lt. Col. Lori Whitney sees as the program’s top priority: patient safety.

“That is our concern. That is the work we do,” said Whitney, who chairs the Defense Health Agency’s Pain Management Clinical Support Service. “A naloxone prescription along with an opioid is just like having an inhaler for asthma or a fire extinguisher in your kitchen. You’re not planning to have a fire every time you cook, but it could happen. Naloxone is that fire extinguisher for opioid overdose, so you want to have naloxone handy to save a life.”

Whitney expects that use of the OEND Program will increase the number of naloxone prescriptions for at-risk patients and their families when opioids are prescribed. The MHS goal is a 90% prescription rate of naloxone to at-risk patients. The OEND program is one way that the organization will meet this goal and has already been successful at its pilot sites.

OEND was piloted in 2019 at Madigan Army Medical Center at Joint Base Lewis-McChord, Washington, to see how the program affects knowledge and prescription rates of naloxone. The medical staff at Madigan took a multipronged approach, training not only opioid prescribers but also outpatient and clinical pharmacists on best practices for naloxone. Dr. Ji Eun Kim, pharmacist and one of the program leads for OEND at Madigan, emphasized the importance of this approach for opioid safety.

“The first time that a patient is prescribed an opioid is with the medical provider who's prescribing it, so that's our first chance to provide naloxone,” Kim said. “Another opportunity is when the patient goes to the pharmacy and the outpatient pharmacy staff reviews the patient's medication list. The pharmacy staff can also provide naloxone if indicated. That's why we thought it’s important and also necessary to train our outpatient pharmacists. We knew that this would work best as a team effort.”

The team at Madigan measured knowledge and understanding of naloxone both before and after completing the OEND pilot program. Kim said Madigan saw an increase in knowledge and comfort for both providers and pharmacists when it comes to naloxone.

“I think with the current opioid crisis and sometimes negative light around using opioids, patients feel like they have to justify why they’re on the prescription,” Kim said. “We need to be able to have a conversation about it with each other and with our patients. I think OEND is a good program and provides information where the pharmacist and providers feel comfortable about having this discussion.”

Whitney hopes that OEND can help more commands and providers reduce stigma and educate patients on opioid safety so they become more comfortable with accepting a naloxone prescription.

“We want to continue to train the providers to have a conversation with their patients and let them know that the answer to pain management isn’t always opioids,” she said. “But if we're going to give you opioids, we also want to give the lowest effective dose for the shortest amount of effective time and we want to keep you safe while you have them. Naloxone is part of that.”

For more information and resources from the Opioid Overdose Education and Naloxone Distribution Program, visit Health.mil.

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