Naloxone Advocacy in Post-Acute and Long-Term Care

We are all familiar with the increased incidence of opioid overdoses and deaths afflicting nation. Fatalities linked to unsupervised or unauthorized prescription use, adverse drug events due dangerous high-risk prescribed combinations, illicit street substances used by those who have become addicted. The 2022 Centers for Disease Control Prevention (CDC) “Clinical Practice Guideline Prescribing Opioids Pain” cautions providers about consequences including when initiate opioids, how assess risks, ways address potential harms use (MMWR Recomm Rep 2022;71;1–95, https://bit.ly/3Wbn4Ml). What can post-acute long-term care facilities do protect their residents from death overdose? Naloxone, antagonist reverse an overdose, is a key element any overdose planning strategy, this life-saving should be available readily accessible in facilities. According Medicare & Medicaid Services State Operations Manual (SOM), Appendix PP (Feb. 3, 2023, https://bit.ly/3z2EYYk), written policy addressing that also addresses best practices related naloxone, it, what type naloxone available, standing orders facilities, exceptions on not end-of-life-care hospice benefit, perform practice sessions as part routine preparedness. Evolving admission at include accepting then care-planning behavioral health concerns. Facilities being challenged accept diverse needs, substance disorders medication treatment needs such methadone maintenance buprenorphine medication-assisted (MAT). Consolidated Appropriations Bill 2023 included provisions relax requirement special “X” waiver encourage registered Drug Enforcement Administration (DEA) prescribe disorder. U.S. Food provides resources medications MAT (“Information About Medication Assisted Treatment,” Feb. 14, 2019, http://bit.ly/3FIXXee). As expected, March 29, FDA approved over-the-counter (OTC) nasal spray form (FDA News Release: https://bit.ly/41qFVGc). This action follows series acknowledgments need make more (see, example, M. Sokolowska, “CDER’s Continued Efforts Widen Naloxone Access,” From Our Perspective, 2, http://bit.ly/3JykVWR). All 50 states District Columbia access statutes Good Samaritan laws; many requirements co-prescribe time ordered. However, there nuances regulations pertains nursing homes. For New York Public Health regulation “Opioid Overdose Prevention,” enacted December legislature, homes general hospitals exempt (Section 3309, point 7, http://bit.ly/3lwtSrO). Polysubstance another consideration. only effective treating overdoses; it has no known reversal effects nonopioid drugs may been consumed. commonly substance, xylazine, reportedly found within other (“FDA Warns Risk Xylazine Exposure Humans” [letter], FDA, Nov. 8, 2022, https://bit.ly/3Jzyq8x). Providers administered but response after two three doses consider cause symptoms. assessment determine which areas priority. ensuring emergency kit automated dispensing system intervention first step. Many chosen keep injection (0.4 mg/mL vial) selection; others decided add (4 mg/0.1 mL). Either made least wherever possible because multiple necessary overdose. It advisable discussion provider pharmacy consultant pharmacist most economical product these kits. Alternatively, facility decide naloxone-specific orders, concurrently prescribed. In case, having specific template order either helpful if facility’s electronic record library. Resident-specific will ensure availability would dispensed pharmacy. Residents receiving opioids risk respiratory depression behaviors could triggered prescribing. factors pre-existing conditions, current medications, history implement some tools Index Serious Opioid-induced Respiratory Depression (RIOSORD) (Pain Med 2018;19:68–78) National Institute Abuse’s Opioid Tool (ORT) (http://bit.ly/40uG7E3). SOM directives requiring staff receive training resident appearances disorder (see F697 “Pain Management,” https://bit.ly/3z2EYYk). Education modules inclusive encounter residents, housekeepers, maintenance, kitchen staff, vendors, consultants. advocacy includes competency administer doses. procedures describe types stored kits systems well likely scenarios identifying potentially experiencing event. A wish enact medical director’s “standing policy,” confer ability resident, visitor. check laws your individual state before instituting policy. Finally, requires practice. providing education critical resource holding drill put into action. Much like drills, give team additional information acknowledge success identify gaps require improvement. Nursing Home Policy Procedure Toolkit created IPRO Quality Innovation Network–Quality Improvement Organization (QIN-QIO Resource Library, Jan. 31, http://bit.ly/40kipKI), directors review nursing, administrators, pharmacists. Sample policies tailored facility. Mr. Accetta board-certified geriatric pharmacist, president/owner Rivercare Consulting, LLC, strategy consulting business PALTC organizations, senior IPRO. Rob currently serves board American Society Consultant Pharmacists (ASCP).