UNM sets protocol for opioid patients
Those with chronic pain will be co-prescribed overdose-reversing drug
Many chronic pain patients rely on drugs that have the potential to kill them.
To counter that threat, University of New Mexico researchers have developed a groundbreaking procedure intended to improve the odds for patients who rely on narcotic painkillers by co-prescribing naloxone, a drug that reverses the effects of an opioid overdose.
Researchers developed the protocol in a yearlong study that enrolled 164 patients at the UNM Pain Center, said co-author Dr. Joanna Katzman, the center’s director. The study was published in April in the journal Substance Abuse.
Researchers found that education is a key step
in successfully prescribing naloxone, also known by the brand name Narcan.
“We found we could educate patients and their family members in about 10 minutes,” Katzman said. “We try to get family members and friends in the room with the patient.”
The involvement of family and friends is crucial because naloxone can’t be self-administered by a person experiencing an overdose, she said.
Narcotic painkillers accounted for nearly half of New Mexico’s 536 drug overdose deaths in 2014, but many people depend on drugs such as hydrocodone and oxycodone to cope with the potentially crippling effects of chronic pain.
The study marked the first time that all patients at an outpatient pain clinic were co-prescribed opioids and naloxone at the same time.
Co-prescribing naloxone and opioid drugs “can be a simple, streamlined and valuable addition” at all outpatient clinics where opioid drugs are prescribed, the study concluded.
Prescription opioids caused 265 deaths, or nearly half the state’s 536 overdose deaths in 2014, the most recent year for which complete data is available.
New Mexico’s 2014 overdose death rate exceeded 26 per 100,000 population, second only to West Virginia’s. In 2015, the total number of overdose death in New Mexico declined by 9 percent to 493.
Today, all UNM Pain Center patients who receive a prescription for opioid drugs also get a prescription for naloxone, Katzman said.
Naloxone works by reversing the depression of the central nervous system and respiratory system caused by opioids, which include heroin and a variety of prescription painkillers.
New law
Gov. Susana Martinez signed a bill into law this year intended to expand access to naloxone.
Under the law, the New Mexico Department of Health issued a statewide standing order in March that allows any New Mexico pharmacist to dispense naloxone without a prescription to anyone who asks for it.
UNM expanded the protocol this year to some 300 patients enrolled in its Alcohol and Substance Abuse Program, or ASAP, which treats patients for heroin and opioid addiction.
Addicts are at greatest risk of overdose in first days after they begin treatment using opioid-replacement drugs such as methadone and suboxone, said Dr. Snehal Bhatt, medical director of ASAP.
Patients receive a two-dose naloxone rescue kit and instructions how to use the drug during their first visit to the clinic, Bhatt said.
“As part of our intake, we have one of our research team members talk to them right then and there,” Bhatt said. “Our patients are actually at a very high risk of an overdose. It doesn’t make sense to wait.”