Over the past few years, federal and state health officials have worked to get Narcan, a drug that can reverse opioid overdoses, into the hands of more people.
Pharmacies in Nebraska have made Narcan, or naloxone, available to all residents, often at no cost. A website run by a statewide campaign called Stop Overdose Nebraska allows Nebraska residents to search for pharmacies near them that carry the drug.
A change in Nebraska Medicine’s electronic medical records software appears to be boosting those efforts.
In August, the health system added a notice to its patient records system, known as One Chart, which alerts health care providers ordering opioids for patients who meet certain criteria that they also prescribe them naloxone.
Since the alert issued in August, the number of naloxone prescriptions filled at health system pharmacies has risen from 36 in the five months before the move to more than 1,290, said addiction psychiatrist Dr Alëna Balasanova at Nebraska Medicine.
Additionally, the number of naloxone prescriptions statewide increased about four or five times in August from the previous average of 150 to 180 prescriptions per month. The number remained well above that level until December, the last month for which data was available. The data was collected by CyncHealth, which contracts with the Nebraska Department of Health and Human Services to run its prescription drug monitoring program.
Kevin Borcher, vice president of pharmaceutical informatics at CyncHealth, said more research would be needed to confirm that the Nebraska Medicine project had a direct impact on statewide prescription numbers.
But Balasanova noted that Nebraska Medicine has clinics throughout the Omaha metro area and other hospitals elsewhere in the state use its medical records system.
“We want to flood the community with naloxone,” she said, “because we know it’s the #1 thing that can help reverse an opioid overdose.”
Balasanova said a naloxone prescription might be warranted when opioids are prescribed to people with respiratory illnesses or other conditions that affect breathing. The same is true for people taking other medications that can interact with opioids and impact breathing.
Even when a person takes an opioid as prescribed, the drugs can lead to an accidental overdose if breathing slows or stops. Most opioid overdoses, Balasanova said, are accidental.
“I consider naloxone a fire extinguisher,” she said. “You want to have it in your house just in case something ever happens. You never expect to use it, and you don’t want to use it either. But, my God, if you end up having a fire, aren’t you glad you have that fire extinguisher?”
More than 200 Nebraskans died of drug overdoses in 2020, an increase of nearly 43% from the previous year, according to a report last summer from the federal Centers for Disease Control and Prevention.
The CDC report did not specify which drugs are responsible for the overdose deaths. In Nebraska, Balasanova said, methamphetamines, not opioids, were the main contributor.
Balasanova said the change to the medical records system came from feedback she received while meeting with other Nebraska drug providers. She is leading an effort for the state health department to educate providers on opioid safety as part of a CDC grant.
In a separate but related initiative, Balasanova also led an effort to create a new prescription set, added to the system in December, that provides a way to assess patients for opioid withdrawal and offer treatment options. .
Kristin Daniel, coordinator of Nebraska Medicine’s pharmacist program for pain management, said officials changed the medical records system to make it easier to prescribe naloxone.
“It’s just good to know that we’re increasing the availability of naloxone,” Daniel said. “If we avoid a single death, then it’s worth it.”