Naloxone Distribution on the Inpatient Psychiatric Unit: Identifying Gaps Between Current Prescribing Practices and Patient Need.

OBJECTIVE: Opioid overdoses are a major cause of mortality, and naloxone, an effective opioid antagonist, plays a critical role in reversing overdoses. This study aimed to evaluate naloxone prescribing practices by psychiatry residents on inpatient psychiatric units, and to assess residents' attitudes toward prescribing naloxone.

METHODS: This quality improvement initiative involved a retrospective chart review of patients admitted to a 64-bed standalone psychiatric hospital between December 2023 and March 2024, and who were identified as being at elevated risk for opioid overdose (N = 90, 64 male, 26 female). Demographic information and naloxone kit provision at discharge were reviewed. Following data collection, a resident reeducation session was conducted, with pre- (N = 24) and post- (N = 17) surveys assessing knowledge, attitudes, and barriers to naloxone distribution.

RESULTS: Among patients identified with elevated risk for opioid overdose, 37.8% received a naloxone kit prior to discharge. No significant relationships were found between naloxone prescribing and overdose history, urine drug screening result, diagnosis, or any sociodemographic factors. Results from the pre- and post- training surveys administered to the residents demonstrated that although 100% felt responsible for offering kits, approximately one third rarely did so, citing time constraints and workflow confusion.

CONCLUSIONS: Naloxone is under-prescribed to patients at elevated risk of opioid overdose in inpatient psychiatric settings. To address this, naloxone should be offered to all patients upon discharge. Streamlining workflow procedures and enhancing resident education could facilitate increased naloxone distribution and improve community access, ultimately reducing overdose rates.