Establishment of a pharmacist-led service for patients at high risk for opioid overdose

Am J Health Syst Pharm. 2018 Mar 15;75(6):376-383. doi: 10.2146/ajhp170294.


Purpose: A program at a family medicine clinic to provide naloxone prescriptions in conjunction with education on naloxone use and opioid hazards to patients at risk for opioid overdose is described.

Summary: Consistent with a 2016 Centers for Disease Control and Prevention (CDC) guideline on opioid prescribing for chronic pain, a family medicine clinic implemented updated controlled substance agreements and medical record templates for documentation of pain management visits and established a pharmacist-led naloxone clinic. Chart reviews were performed to identify patients eligible for naloxone, as defined by the CDC guideline. A standard visit template was constructed to guide patient education regarding overdose risks and naloxone use. The teach-back method was used to ensure patient understanding, and patients were encouraged to bring a friend or family member to clinic visits. To address medication access barriers, community resources for patient referral for assistance were identified. Barriers to attendance at pharmacist-conducted visits necessitated changes in clinic workflow to incorporate education into prescheduled physician visits and education of some patients via telephone. During the first 6 months of clinic operations, 49 patients were identified as being at risk for opioid overdose; pharmacists educated 84% of those patients and subsequently confirmed that 69% had filled a naloxone prescription.

Conclusion: Naloxone prescribing and provision of education on naloxone use to at-risk patients in a family medicine clinic can help ensure access to life-saving medication and reinforce CDC recommendations on safe prescribing of opioids.

Keywords: ambulatory care; education; family practice; naloxone; opioid analgesics; pharmacists.

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Chronic Pain / drug therapy*
  • Drug Overdose / prevention & control
  • Family Practice / organization & administration
  • Humans
  • Naloxone / administration & dosage
  • Narcotic Antagonists / administration & dosage
  • Patient Education as Topic / methods
  • Pharmaceutical Services / organization & administration*
  • Pharmacists / organization & administration*
  • Practice Guidelines as Topic


  • Analgesics, Opioid
  • Narcotic Antagonists
  • Naloxone