ABSTRACT #33

Naloxone Curriculum For Palliative Medicine Fellows

Caitlyn Kuwata, Laura Gelfman

PURPOSE AND GOALS: Naloxone is a vital tool in the harm reduction movement to address opioid overdose. Per the 2022 CDC Guidelines for Prescribing Opioids, ambulatory patients at increased risk for opioid overdose should receive a co-prescription of naloxone with an opioid prescription. In palliative medicine, community dwelling patients with serious illness are often prescribed opioids for cancer related pain. While the Hospice and Palliative Medicine ACGME milestones include competencies about opioid risks and adverse effects, there are no specific guidelines regarding use of naloxone in this population. Furthermore, there is variability in palliative care providers’ comfort level for naloxone prescribing. The purpose of this educational project was to create and assess a curriculum focused on naloxone prescribing in the palliative care population.

METHODS: All 1st year palliative medicine/2nd year integrated palliative-geriatric fellows received an interactive lecture on naloxone prescribing for patients with serious illness; fellows used role-playing during the session to practice naloxone education for patients.

EVALUATION PLAN: To evaluate the prescribing patterns of the fellows, an audit of outpatient palliative charts was conducted to identify the percentage who received a naloxone co-prescription with an opioid. Anonymous pre- and post- intervention surveys of the fellows assessed attitudes towards naloxone use and prescribing practices.

SUMMARY OF RESULTS: Of the 64 charts reviewed, 23 (35%) patients seen at the palliative care clinic received a co- prescription of naloxone and an opioid. Twelve fellows completed the pre-intervention survey, in which 4 (33%) palliative medicine/integrated fellows previously received training on naloxone. While most fellows (75%) agreed they had both good knowledge and confidence in prescribing naloxone to patients, fewer reported they felt knowledgeable (25%) and confident (50%) with prescribing naloxone to patients with serious illness. The majority of fellows did not agree naloxone use would lead to negative outcomes like effecting patient-provider relationship, increased risky behavior, or unintended consequences. Five (42%) completed the post-intervention survey. 100% of respondents agreed or strongly agreed they are knowledgeable in their ability to prescribe naloxone to patients with serious illness.

REFLECTIVE CRITIQUE: Naloxone can be a life-saving medication in the event of opioid overdose. Given palliative care patients are often prescribed opioids for management of cancer related pain, it is imperative that naloxone co- prescribing be routinely considered for this population. This project provided initial education for palliative medicine and integrated palliative/geriatric fellows on this important topic. The small post-intervention response limits the ability to draw conclusions regarding the intervention’s ability to impact attitudes about prescribing naloxone. Future chart audits will determine the effectiveness of this curriculum in increasing naloxone co-prescribing in clinic.