What’s the Risk? Naloxone Co-Prescribing in an Outpatient Palliative Care Clinic (FR440C)

Abstract

•List the three most prevalent risk factors for opioid-induced respiratory depression in patients receiving palliative care.•Discuss the potential benefits and burdens of naloxone co-prescribing in palliative care. Centers for Disease Control and Prevention (CDC) guidelines on opioid prescribing for chronic pain recommend co-prescribing naloxone for patients with risk factors for Overdose or Serious Opioid-induced Respiratory Depression (OSORD). While palliative care is excluded from this guideline overall, many patients receiving palliative care need chronic opioid therapy; prevalence of OSORD risk factors in this population is unexplored. This study aims to 1) describe prevalence and patterns of risk factors for OSORD among ambulatory palliative care patients at an academic medical center and 2) identify frequency of naloxone co-prescribing in a pilot initiative using an integrative risk tool, the Risk Index for OSORD (RIOSORD). Patients taking opioids and followed in outpatient palliative care in March–June 2017 were included in this retrospective chart review. Demographics, published risk factors for OSORD, RIOSORD score, and naloxone prescription were extracted. RIOSORD score ≥ 18 was designated as indication for naloxone co-prescription. Descriptive statistics were used to evaluate data. Risk factors of note among 91 included patients were prescription of ER/LA opioid formulation(s) (54.9%), benzodiazepine(s) (29.7%), MEDD > 100 mg (49.5%), and MEDD > 50 mg (74.7%). Sixty-one patients (67.0%) had an indication for naloxone, and 28 of these patients (45.9%) were co-prescribed naloxone. Naloxone may have been appropriate for an additional 18 patients if single AMA or CDC recommendations were applied. Twenty-one patients had RIOSORD scores in the highest risk class. Sixty-seven percent of patients had active cancer; 14% were in survivorship. Patients receiving palliative care have similar risk factors for OSORD versus patients without serious illness and may benefit from naloxone co-prescription, when consistent with their goals of care.