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Co-prescribing

Early access to the opioid reversal agent naloxone through community-based models has demonstrated positive outcomes during its use in the last decade. Patients at risk for overdose and their loved ones can be educated on opioid overdose symptoms and administration of naloxone in the community setting. Prescribers and pharmacists can be trained to identify patients at high risk for overdose. In some states, pharmacists can independently prescribe naloxone or can enter into collaborative practice agreements with prescribers to increase access to this life-saving medication. Co-prescribing has benefits for both chronic pain patients as well as patients with opioid use disorders.

Consider co-prescribing naloxone in these situations:

  • Recently rotated to a new opioid
  • Prescribed morphine equivalent daily (MED) dose of 50mg or more
  • On long-acting opioids particularly if in conjunction with short-acting opioids
  • Poly-opioid use
  • Prescribed opioids greater than 30 days
  • Over the age of 65 years
  • Households with people at risk of overdose such as children or someone with a substance abuse disorder
  • Patients who have difficulty accessing emergency medical services (distance, remoteness, lack of transportation, homelessness, and/or without phone services)
  • Recent mandated substance use treatment, incarceration, or period of abstinence with history of drug abuse
  • Concurrent prescription or over-the-counter medications
    • Benzodiazepines
    • Antipsychotics
    • Antiepileptics
    • Muscle relaxers
    • Hypnotics
    • Sedatives
    • Antihistamines

Pharmacist Mentors for Co-prescribing Naloxone

Please contact a naloxone mentor in your IHS Area [PDF - 156 KB] for assistance with creating a naloxone co-prescribing initiative at your site. Mentors can provide an overview of the training materials, program best practices, and offer specific technical assistance.

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