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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03337100
Other study ID # CO-16-2405-02
Secondary ID 1R01DA042059
Status Completed
Phase N/A
First received
Last updated
Start date November 27, 2017
Est. completion date September 30, 2022

Study information

Verified date March 2023
Source Kaiser Permanente
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

In the setting of naloxone standing orders, this study will assess if co-dispensing naloxone with opioids to patients prescribed chronic opioid therapy changes opioid risk behaviors, increases naloxone uptake, and increases knowledge about overdose and naloxone.


Description:

This is a pragmatic, pharmacy-based, cluster randomized controlled trial of a naloxone co-dispensing program for adults prescribed chronic opioid therapy. Pharmacies (target N=6) will be randomized to the order in which they are encouraged to implement a naloxone co-dispensing program for patients prescribed chronic opioid therapy. The intent of this program is to provide patients prescribed chronic opioid therapy naloxone for potential opioid overdose reversal under the terms of a standing order. Participants prescribed chronic opioid therapy who use randomized pharmacies will be recruited to receive knowledge and risk surveys at baseline and over the follow-up. The primary outcome is opioid risk behaviors (target enrollment is 200 patients). Secondary outcomes include knowledge about overdose and naloxone, substance use, and pain intensity. Patients who use randomized pharmacies (anticipated n=550 patients) will also be followed in the electronic health record for secondary outcomes: naloxone dispensings, changes in opioid dose, aberrant urine toxicology results, and overdose events.


Recruitment information / eligibility

Status Completed
Enrollment 7
Est. completion date September 30, 2022
Est. primary completion date April 30, 2021
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Study Population: - Eligible pharmacies - Patients prescribed chronic opioid therapy Inclusion Criteria for pharmacies: - Stock naloxone for outpatient dispensing. - Pharmacy leadership willing to provide naloxone under a co-dispensing protocol. - Pharmacy leadership willing to be randomized to order of implementation. - Have or can implement a naloxone standing order. Exclusion Criteria for pharmacies: • None Inclusion Criteria for patients: - Prescribed chronic opioid therapy and meet criteria for the pharmacy co-dispensing protocol - Receive medications at participating pharmacies - Have a health plan which covers the formulation of naloxone available at the pharmacy they received their opioid prescriptions from. - (for surveys)18 years of age or greater Exclusion Criteria: • (for surveys) Non-English speaking, hospice enrollment, do-not-resuscitate order

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
Co-Dispensing
Implementation of a naloxone co-dispensing pharmacy program. The intent of this program is to provide patients prescribed chronic opioid therapy naloxone under the terms of a standing order for potential opioid overdose reversal. Prior to implementing the program, a naloxone standing order will be implemented and pharmacy operational staff will provide training to pharmacy staff about the standing order and a naloxone co-dispensing protocol. Under a co-dispensing protocol, pharmacy staff members will identify opioid prescriptions meeting criteria for co-dispensing, prepare naloxone fills, offer patients naloxone, and provide counseling on its use.

Locations

Country Name City State
United States Denver Health Denver Colorado

Sponsors (3)

Lead Sponsor Collaborator
Kaiser Permanente Denver Health and Hospital Authority, National Institute on Drug Abuse (NIDA)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Other Change in Pain Intensity Among survey participants, pain intensity will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS Scale v1.0 - Pain Intensity 3a. The PROMIS Pain Intensity instrument is scored on a scale of 3-15. A higher score represents greater pain intensity. Change from baseline to 4-6 months and 8-10 months
Other Rate of Opioid Overdose Among survey participants and participants followed using automated data only, overdoses will be assessed using electronic health record and insurance claims data and death records. Survey participants will be asked about non-fatal overdose events. Baseline up to 2.5 years
Other Rate of Aberrant Urine Toxicology Screens Among survey participants and participants followed using automated data only, urine toxicology screen results found in laboratory databases will be used to measure opioid medication diversion and drug use. Baseline up to 2.5 years
Primary Change in Opioid-Related Risk Behavior Among survey participants, risk behavior will be assessed using the Opioid-Related Behaviors in Treatment (ORBIT) scale. The ORBIT is a scale used to identify recent risk behavior among patients receiving chronic opioid therapy. Scores on the single scale range from 0-40, with lower values representing less risk behavior. Change from baseline to 4-6 months and 8-10 months
Secondary Overdose and Naloxone Knowledge Among survey participants, knowledge of overdose and naloxone will be measured using survey items adapted from the Opioid Overdose Knowledge Scale (OOKS). The OOKS is a scale measuring knowledge of overdose risks, warning signs, steps to address the overdose and appropriate use of naloxone. The investigators have adapted it to be specific to prescription opioids. The modified-OOKS is scored on a scale of 0-28, with higher values representing greater knowledge about overdose and naloxone. Change from baseline to 4-6 months, and 8-10 months
Secondary Rate of Naloxone Dispensings Among survey participants and participants followed using automated data only, pharmacy and insurance claims databases will be used to identify naloxone dispensings. Baseline up to 2.5 years
Secondary Patient reported naloxone pick-up Among survey participants, surveys will be used to identify naloxone dispensings in the outpatient setting. Baseline up to 10 months
Secondary Changes in opioid dose Among survey participants and participants followed using automated data only, changes in the milligrams morphine equivalent dose will be calculated from pharmacy and insurance claims databases. Baseline up to 2.5 years
Secondary Change in Drug Use Risk Behavior Among survey participants, drug use risk behavior will be assessed using question 2 of the validated National Institutes on Drug Abuse-Modified Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scale version 2.0. The investigators added an item about tobacco use from the WHO ASSIST V3.0 to the NIDA-modified ASSIST V2.0 instrument, resulting in a scale of 0-66, with lower values representing less drug use risk behavior. Change from baseline to 4-6 months and 8-10 months
Secondary Change in Hazardous Drinking or Alcohol Use Disorders Among survey participants, alcohol use risk behavior will be assessed using the validated Alcohol Use Disorders Identification Test--Consumption (AUDIT-C) scale. The AUDIT-C is a screener used to identify patients with alcohol use disorders or hazardous drinking behavior. The AUDIT-C is scored on a scale of 0-12. The higher the score, the more likely it is that the patient's drinking is affecting his or her safety. Change from baseline to 4-6 months and 8-10 months
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