Evaluation of a Pharmacist-Integrated Model of Opioid Use Disorder Treatment to Increase Naloxone Co-Prescribing in Primary Care

NIDA, F31DA060690

6/1/2024-6/1/2026

Jesse S. Boggis, MPH (Northeast Node, Center for Technology and Behavioral Health, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth)

Sponsor: Lisa A. Marsch, PhD, Northeast Node, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth.

Consultants: David A. Fiellin, MD, New England Consortium, Yale School of Medicine; Karen Schifferdecker, PhD, MPH, Geisel School of Medicine at Dartmouth; Erika Moen MS, PhD, Geisel School of Medicine at Dartmouth

In the United States overdose deaths remain at near record highs, largely due to the proliferation of illicitly manufactured fentanyl and fentanyl analogues in the illicit opioid supply. Increasing access to the opioid overdose antidote, naloxone, to people at high risk of experiencing or witnessing an overdose is a public health intervention shown to reduce overdose death. Nearly half of the US states have a provision related to prescribing naloxone to patients at risk, namely patients prescribed medication for opioid use disorder (OUD), known as co-prescription. However, our recent modelling study suggests that most states are neither co-prescribing nor dispensing enough naloxone to reach our goal of preventing 80% of witnessed opioid overdose deaths. While the most recent federal approval of the first over-the counter (OTC) naloxone formulation will help increase access for people who can afford OTC naloxone, it is unknown how this approval may affect access for people receiving medication treatment for OUD in primary care. Co-prescribing naloxone in primary care has the potential to fill what has been a persistent gap in the overdose crisis response. There is growing evidence that pharmacists may be willing and able to help increase OUD care team capacity for co-prescribing naloxone in primary care. While studies have engaged pharmacists to increase access to naloxone, no studies have integrated pharmacists within the primary care team to increase co-prescribing naloxone.

The NIDA Clinical Trials Network CTN-0116 parent study (PI: Marsch) to this F31 project is ongoing and aims to evaluate the feasibility, acceptability, and impact of implementing a promising pharmacist-integrated model of medication treatment for OUD (PrIMO) in four primary care sites in four states.

The objective of this F31 project is to investigate whether PrIMO may increase primary care capacity for co-prescribing naloxone within the parent study. The project aims to: (1) Describe federal, state, and clinic-level policies and current OUD interventions which impact co-prescribing naloxone within four PrIMO primary care sites in four states. (2) Investigate care team knowledge and attitudes regarding naloxone, emerging OTC naloxone guidance, and patient overdose across PrIMO implementation, and (3) Evaluate naloxone co-prescribing to patients receiving medication treatment for OUD by patient demographics, provider type, health insurance, urine drug test results, and (b) test if these associations become stronger or weaker across PrIMO implementation.

This project will be the first-of-its-kind to evaluate how a pharmacist-integrated model of care may increase capacity for naloxone co-prescribing in primary care. An effective collaborative model of care has the potential to create a new national standard of OUD treatment and overdose prevention within primary care.