Edward-Elmhurst Health presciptions for strong opioids come with naloxone order

A prescription for a strong dose of opioid pain relievers from one suburban health network now comes with something else: a doctor's order to get a backup medication in case of overdose.

Edward-Elmhurst Health on Jan. 8 began a new protocol requiring doctors who prescribe certain high doses of opioids to also prescribe a dose of naloxone, an antidote that allows users to regain breathing and consciousness if they overdose.

The new protocol has three goals, said Dr. Aaron Weiner, director of addiction services for Linden Oaks Behavioral Health in Naperville: Prevent deaths, increase knowledge of the danger of opioids and decrease stigma about buying naloxone or taking precautions against addiction.

Doctors who prescribe opioids at doses that are the equivalent of 70 mg of morphine or higher automatically are prompted by their medical records system to also write a prescription for naloxone. Weiner said the health system chose that level as a trigger based on a set of 2016 guidelines from the Centers for Disease Control and Prevention.

When doctors explain the second prescription for naloxone, Weiner said, it should clue in patients to the dangers of opioid medications.

“A lot of times, patients don't know they're on a high dose,” Weiner said. “This prescription is going to raise the level of awareness of everyone about what's going on and the riskiness of being on these drugs.”

Clark Kueltzo, a pharmacist and co-owner of Lombard Pharmacy, said he has been an advocate of naloxone co-prescribing for years and convinced at least one doctor to begin the practice, which helped inform patients.

“Even if they didn't get the script filled, it would sort of frighten them to know, 'OK, I do need this medication, but I've got to be really careful about how I take it,'” Kueltzo said.

Opioids in high doses can be risky, Weiner said, because they slow down respiration and can lead patients to develop a tolerance, requiring a higher dose to achieve the same effect. The stronger the dose, the smaller the window between the desired effect and disaster.

There's also a phenomenon called hyperalgesia, in which the body of someone who gets used to taking pain medication actually creates a new, stronger pain — which further fuels the addictive cycle.

“Your body adapts to the pain medicine by worsening the pain,” Dr. Lewis Nelson, professor and chair of emergency medicine at Rutgers New Jersey Medical School, recently told a group of reporters in Chicago. “Rather than the pain medicine wearing off, the pain worsens.”

That's why experts say having precautionary naloxone is a smart idea. If addiction has set in, naloxone will not cure it, but advocates say it does give users the chance to recognize they have a problem and seek treatment.

“We hope to get more naloxone on the street,” Weiner said, “which will hopefully reduce deaths.”