Providing a box of naloxone to qualifying patients before they walk out the door is a mission for Munson Medical Center pharmacy resident Rachel Pavona, Pharm.D.
It is also her research project.
“Addiction and recovery is actually very personal to me, my brother passed from a heroin overdose in 2011,” she said.
As of Nov. 1, Pavona, along with hospital medication safety pharmacist Julie Botsford, Pharm.D., and support from psychologist Cynthia Nichols, Ph.D., launched a focused effort to educate opioid use disorder patients in the Emergency Department and within the hospital about NARCAN® Nasal Spray and how to apply it should an overdose occur.
Funding for the first 50 doses of the drug – which comes in two-dose boxes – was made available by the hospital’s Behavioral Health Department through its Community Opioid Recovery Expansion grant to expand naloxone and medication-assisted therapies.
While the research project depends in part on other providers and nurses informing Pharmacy of potential patients who can benefit from the project through a process on the patient’s chart,” Pavona found her first patient during her normal residency efforts on a floor of cardiac patients.
“I noticed on her chart, as I looked at her medications, that she had a long history of IV opioid drug use,” she said. “Once I sat down and talked to her about what we were going to do she was super excited and super grateful. She had shared with me that she had actually used NARCAN once before, after her partner had overdosed.”
In researching how to set up the project, both Pavona and her mentor, Botsford, sought to ensure an effective and practical approach.
“We felt it was really important that they go home with this in hand, not just a paper prescription.” Botsford said. “Because we know the literature also suggests that if you give them a prescription to get it filled somewhere, often times they won’t go get it filled. It’s also going to be expensive and they don’t have insurance coverage.”
Some of the potential participants in the project will be identified through the medication-assisted treatment program in the Emergency Department. Others through a referral by nurse or provider in the hospital. In addition to being 18 or older, eligibility for the project includes:
- Patients treated in the Emergency Department or admitted to the hospital due to an opioid overdose.
- Patients with a diagnosis of opioid use disorder.
- Any family member, caregiver, or loved one of a patient who is an opioid overdose victim or with a diagnosis of opioid use disorder who is interested in learning about the administration of NARCAN.
Once a patient is identified, Pavona or an ED pharmacist makes personal contact with the patient and if the patient is willing, provides some counseling, education about NARCAN Nasal Spray, how to administer it, and the need to call 911 to ensure there is not a relapse due to any continued opioid presence in the patient’s system. The patient is then asked to repeat back key points of the education.
The research is tracking response to the education, participant demographics, and pharmacist time with the participants.
As the hospital’s medication safety pharmacist, Botsford said she is happy to help with a project that seeks to help patients who may have initially been introduced to opioids through a prescription that might not have reflected the best patient option.
“Part of my work right now involves ensuring appropriate opioid safety at the hospital and that we are prescribing and using non-opioid therapies when it makes sense to do that,” she said. "I feel that this piece is just really important to help the people in our community have another chance. Really that is what it’s all about. I’ve gone to enough presentations and you start to understand that it takes many attempts at recovery. It might be that 30th time that someone reaches out and shows caring and understanding – and that person makes all the difference in the world.”
Munson Medical Center statistics show that 391 patients were treated in the Emergency Department for opioid use disorder in fiscal year 2019.
For Pavona, whose residency extends to July 1, 2020, the primary purpose of the project is to save a life.
“If I can help just one person and it positively affects them, or helps their family members sleep a little better at night, it will be worth all the hard work that made this research possible,” she said. “And I’m very thankful to Munson Medical Center, everyone has been really receptive to this program.”
To learn more about Munson Healthcare efforts to counter the opioid epidemic go to munsonhealthcare.org/opioid-resources.