Narcan Distribution Project

LOMA LINDA UNIVERSITY EMERGENCY DEPARTMENT NALOXONE DISTRIBUTION PROGRAM

Background

Opioid overdose deaths have substantially increased nationwide secondary to increasing opioid use. To combat the opioid crisis, the California Department of Health Care Services (DHCS) in conjunction with the Substance Abuse and Mental Health Services Administration (SAMHSA) have created a free naloxone distribution program (NDP). The primary objective of this program is to provide education and materials for prevention of opioid overdoses. The traditional approach of writing naloxone prescriptions with the expectation patients will fill the prescription has limited impact in the community.  Emergency Departments (EDs) participating in the NDP have demonstrated a significant increase in naloxone distribution over these prior methods. 

Policy Statement

The goal of this policy is to standardize and outline the naloxone distribution process for Loma Linda University Medical Center Emergency Department. Naloxone distributed in the ED will be supplied to: 1) patients who meet criteria defined as high risk, for potential use in the community, and 2) community members for localized harm reduction. Naloxone distributed in the ED will not be used for acute opioid reversals on LLUMC property nor will LLUMC charge patients for provision of naloxone through this program in accordance with terms and conditions set forth by DHCS. 

Storage

1.     Naloxone for distribution through the DHCS program will be ordered by the ED Substance Utilization Navigator (SUN) and will be received by the LLUMC ED 

2.     Upon receipt, naloxone for distribution will be stored in a locked cabinet in the ED, separated from hospital supply

ED PATIENT DISTRIBUTION

Target Patient Population 

High risk patients who are being discharged and are defined as meeting at least ONE of the below criteria:

1.     >90 mg of morphine or morphine equivalents per day 

2.     Patient discharge from the ED with concurrent opioid prescriptions

3.     History of substance use disorder (SUD), chronic pain disorder, and/or psychiatric disorder

4.     Patients qualifying as high-risk based on Risk Index for Overdose or Serious Opioid-Induced Respiratory Distress (RIOSORD)

5.     Any patient who may be at risk of an opioid-related overdose 

Procedure

1.     High risk patients will be identified by providers based on the criteria listed above 

2.     Providers will place an order for a naloxone kit (naloxone discharge kit order) into LLEAP prior to patient discharge

3.     Trained ED staff will sign out naloxone discharge kits from the locked storage cabinet in the ED

a.     Personnel with access to naloxone kits include, but are not limited to: ED Nursing, Pharmacy, and SUN. 

4.     Nursing and/or physician staff to provide education/counseling to patient and/or visitor prior to discharge

COMMUNITY MEMBER DISTRIBUTION

Community members who decline a medical screening may request a naloxone kit for local harm reduction in accordance with the NDP program. Distribution of naloxone kits for community member use will entail the following:

1.     Community member presents to the ED, declines a medical screening, and requests a naloxone kit for community use

2.     Trained ED staff will sign out a naloxone kit from the locked storage cabinet in the ED

3.     Nursing and/or SUN to provide education/counseling to community member prior to naloxone distribution

Naloxone Recipient Education 

All naloxone recipients will be educated by nursing or physician staff prior to naloxone distribution; education will include appropriate use of naloxone, and further instructions for medical care. Naloxone recipients will also be provided with a video link (QR code) and printed materials illustrating instructions and reiterating how and when to use product.

Documentation 

LLUMC ED is to maintain records of all naloxone distributed through the DHCS program in the corresponding logbook (ED Patient or Community Member). Any reported use of naloxone distributed through this program will be recorded in the “usage reporting” section of the logbook—usage will be reported back to DHCS in accordance with the terms and conditions of the NDP. 

Disposal

Naloxone kits that expire while being stored in the ED will first be donated to a local harm reduction organization, in according with the CA Bridge guidelines. If donation of expired naloxone kits is not feasible, they will then be discarded in the appropriate pharmaceutical waste bins. All naloxone distributed from the ED will contain patient education on proper disposal at home.