Naloxone is now the standard of care for reversing opioid overdoses. However, the stigma about naloxone among health care professionals poses a significant barrier to its distribution. In addition, even medical students who learn to prescribe it and train patients in its use may harbor uncertainty about the legal aspects.
No federal standing order mandates access to naloxone. In July 2020, the Massachusetts Department of Public Health issued a statewide standing order that allows retail pharmacies to dispense the drug without a prescription and requires them to maintain a continuous supply sufficient to meet community needs.
Hilary S. Connery, MD, PhD, clinical director of the Division of Alcohol, Drugs, and Addiction at McLean Hospital, along with students and faculty in the Harvard Medical School (HMS) Substance Use and Pain Curriculum Committee, have developed a streamlined system for equipping medical students with prescription naloxone.
In BMC Medical Education, they describe the results of a prospective study, suggesting that the system is effective.
Methods
The initiative called for students at Harvard Medical School to use the statewide standing order to obtain naloxone from the outpatient pharmacy at Brigham and Women’s Hospital.
The research team collaborated with the pharmacy manager to devise an electronic order form for students to use as long as they are registered through the Brigham network. HMS student health insurance, like most health insurance, ensures a $0 copay.
Beginning in August 2022, the ordering system was publicized at several points during the four-year medical curriculum: during basic life support training, first- and second-year lectures about substance use, a pre-clinical didactic addressing substance use treatment, and in a practicum for fourth-year students on medication-based treatment for substance use disorders.
Beyond integration into the core curriculum, students were invited to complete the form via HMS listservs and at the end of a voluntary extracurricular event that educates attendees on harm reduction techniques.
Results
As of January 2024, 63 of 540 Harvard medical students had used the form to procure a naloxone kit (contains two doses). 30 of the 63 students were recruited by the extracurricular event on harm reduction.
All orders for naloxone were filled by the Brigham pharmacy.
Expansion Planned
This initiative was spearheaded by medical student leadership at HMS focused on expanding substance use and pain education. Facilitating naloxone distribution by medical students normalizes the carrying of the drug and will hopefully give new physicians the confidence, empathy, and clinical knowledge to care for patients experiencing substance use disorder.
The workflow proposed here capitalizes on existing connections between a medical school and its affiliated hospitals, so it is easily customizable and generalizable to medical schools across the country.
The team is working to extend the intervention to patient-facing naloxone order forms in emergency departments, infectious disease clinics, and other clinics that serve a higher proportion of patients experiencing substance use disorder.
Additionally, the team plans to establish in-hospital booths staffed regularly by pharmacists to allow patients to fill naloxone prescriptions in under five minutes.
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