1. Cindy Powers Magrini, PharmD, BCPS
Clinical Pharmacy Specialist Positive Health Clinic

2. Naloxone Prescribing at The Positive Health Clinic Cindy Powers Magrini, PharmD, BCPS Clinical Pharmacy Specialist, Positive Health Clinic (PHC)
July 31, 2012 2

3. Introduction to the PHC
Clinic offers early HIV intervention and treatment using a harm reduction model
Funded through a federal grant under the Ryan White CARE Act of
~750 HIV-positive patients
5 physicians
2 nurse practitioners
3 nurses
4 social workers
2 medical assistants
1 patient advocate
1 data analyst
1 grant coordinator
1 administrative director
1 pharmacist 3

4. Cristina Elgins’s Presentation for PHC Staff
Local trends in overdose
National trends in overdose
Strategies for preventing opioid fatalities
Prevention Point Pittsburgh
Other naloxone prescribers in Pittsburgh
Project Lazarus
Legality of prescribing naloxone—Temple University School of Law Memo
How to treat an overdose situation

5. Naloxone Prescribed When:
1. Patient release after emergency medical care involving opioid OD/intoxication 2. Suspected history of illicit or nonmedical opioid use 3. High-dose opioid prescription (> 50 mg of morphine equivalence/day) 4. Any methadone prescription to opioid naïve patient Any opioid prescription and … 5. smoking/COPD/emphysema/asthma or other respiratory illness 6. renal dysfunction, hepatic disease 7. known or suspected concurrent alcohol use 8. concurrent benzodiazepine prescription 9. concurrent SSRI or TCA anti-depressant prescription

6. Naloxone Prescribed When:
10. Prisoner released from custody
11. Release from opioid detoxification or mandatory abstinence program
12. Voluntary request from patient
13. Patients in methadone or buprenorphine detox/maintenance (for addiction or pain)
14. Patient may have difficulty accessing emergency medical services (distance, remoteness)
15. Other (specify): ____________________________________

7. Policy and Procedure Creation
Intranasal Naloxone Policy
Controlled Substances Policy
Any patient with an opioid prescription can be ordered intranasal naloxone by either a nurse or pharmacist per protocol
Any patient who has a known history of opioid misuse will be offered a prescription for intranasal naloxone after discussion with a prescribing practitioner

8. Patient Education
Patients and family members or friends will watch the intranasal naloxone training video (produced by PPP)
Staff will review the patient education checklist
Patients will be given the opportunity to ask questions

9. Naloxone Dispensing at PHC
After the patient has been educated, they will leave the clinic with naloxone in hand that has been dispensed from clinic stock
The clinic stock will be replaced by placing an order with the clinic’s contract pharmacy
The order will be adjudicated with the patient’s insurance, if applicable
The replacement stock will be received at the clinic next day

10. Naloxone Dispensing at PHC

11. Challenges and Obstacles
Mechanism for patient education that is sustainable
Naloxone shortage
EHR implementation
Prescribers
Raises uncomfortable issues for prescribers

12. Questions