Identifying High-Risk Beneficiaries
While any beneficiary who requests naloxone can receive it, pharmacists received training and tools to better identify those most likely to need the opioid antagonist.
When a beneficiary presents an opioid prescription, “MTF pharmacists at the outpatient window use the Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression, known as the RIOSORD, to determine whether or not a beneficiary is at risk for overdose,” Dwyer explained. “This is a nationally recognized, validated screening tool used to estimate the likelihood of overdose among users of prescription opioids. If the beneficiary’s RIOSORD score is over 32 (maximum score of 115), naloxone is recommended.”
RIOSORD is embedded in the MTF CarePoint Look-Up Tool, which has seen a dramatic increase in use since issuance of the DHA-procedural instruction. In the six months prior to the new policy, MTF pharmacists used the tool 8,708 times. In the 11 months after the expansion of naloxone access, pharmacists used the tool 48,514 times, Dwyer reported.
The new policy required all pharmacists to receive training on naloxone before they could prescribe it. DHA recommends several industry standard courses and developed and distributed educational materials to further explain the procedural instruction. Materials also were developed for patients and caregivers.
“The educational materials highlight the appropriate use and administration of naloxone, beneficiary counseling and provide links to resources from other government agencies, such as the U.S. Food and Drug Administration and the Substance Abuse and Mental Health Services Administration,” Dwyer said.
With the combination of materials, focused education and expanded access, he noted, “Naloxone education and training has become a core competency for clinical pharmacists.”
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Abouk R, Pacula RL, Powell D. Association Between State laws Facilitating Pharmacy Distribution of Naloxone and Risk of Fatal Overdose. JAMA Intern Med. 2019 May 6;179(6):805-811.
