Helping to Identify Patients at Risk for Opioid Overdose Improvements to the NC Controlled Substance Reporting System (CSRS) makes it easier for pharmacists to access important controlled substance related information for their patients. The system provides an “Overdose Risk Score” (ORS) that correlates with a daily morphine milliequivalent dose (MMED) range. Patients with a ORS of 450-650 equates to >50-90 MMED, and those with an ORS of 650 or greater have an MMED of greater than 90. Patients at greater risk for overdose are: ·
MMED > 50
·
Concomitant use of an opioid and a benzodiazepine
·
Concomitant use of an opioid and alcohol
·
Patients with respiratory disease (including smoking), liver disease, renal disease, HIV/AIDS, or cardiac disease
Pharmacists can help make sure patients at greater risk for opioid overdose have naloxone on hand; and ensure that the patient can convey to family and friends, the signs and symptoms of an overdose, and how to administer naloxone in the event of an overdose. Use the patient’s history, concomitant medications, and their ORS (calculated by the CSRS) to help identify patients for naloxone dispensing. The naloxone standing order can be used to dispense naloxone to patients you proactively identify as being at risk.
North Carolina Pharmacist
Page 45
Volume 99 Number 4 Fall 2018
