(10) Patient-Centered Design: Improving Naloxone Access Through Patient Insights

Background & Introduction: Although opioid overdoses in the United States declined in 2024, the crisis remains a major public health concern. Increased access to naloxone—a medication that reverses opioid overdose—has contributed to recent improvements. In 2021, Kaiser Permanente Northwest (KPNW) launched the Zero Overdose initiative to expand naloxone awareness and access for patients at elevated risk. This work included patient mailers, pharmacy‑based education with QR‑linked instructions, updated emergency response protocols, and new systems to identify high‑risk patients and support consistent prescribing practices.
Data from the Enterprise Pharmacy Information Management System (ePIMS) show that about 70% of high‑risk patients obtain naloxone when a physician issues a prescription. High‑risk criteria include receiving an opioid prescription exceeding 50 morphine milligram equivalents (MME), a new or existing diagnosis of opioid use disorder, a history of overdose, or an overdose history combined with a benzodiazepine or Z‑drug prescription. A physician’s order also triggers follow‑up steps across clinical teams and enables patients to use pharmacy benefits, making access more likely.
To better understand why the remaining 30% do not fill prescriptions, KPNW conducted a survey to identify barriers and inform patient‑centered, scalable strategies to improve naloxone access across the region.

Methods: Using electronic health record (EHR) data, we identified 7,302 adult (aged > 18) KPNW Health Plan members with a naloxone order between September 15, 2023, and September 15, 2024. Of these, 4,713 (64.5%) had filled their naloxone prescription and therefore were not eligible to receive a survey. At the time of the survey, 2,531 had an active order but no evidence of a pharmacy dispense in the EHR and an active email address. These individuals were invited via email to participate in a web-based survey with an opportunity to enter a lottery for a gift card. Up to two reminders were sent to non-respondents over the ten days following the initial email invitation. Significance testing comparing responders and non-responders and comparing individuals who filled or did not fill a naloxone prescription used chi-square tests for categorical variables and ANOVA for continuous variables. The Kaiser Permanente Interregional Institutional Review Board determined that this was a quality improvement project and did not require consent.

Results: Electronic Health Record (EHR) data identified 7,302 patients with a naloxone order in the study period. Of these:
4,713 patients (64.5%) had filled their naloxone prescription
2,589 patients had not filled their prescription at the time of the survey

These 2,589 individuals were invited to participate in an emailed survey. A total of 481 responses were received, resulting in a 19% response rate (481 out of 2,531 valid email contacts).

Among the 481 respondents, 203 (42%) reported that they had obtained naloxone despite EHR data indicating the prescription was unfilled. Of these:
45% said they obtained naloxone because their physician prescribed it and emphasized its importance
Only 8% cited personal concern about experiencing an overdose
37% reported obtaining naloxone out of concern they might witness an overdose in the community

The remaining 275 respondents (55%) had not obtained naloxone. Their reasons included:
55% felt they didn’t need it
15% were unaware they had a prescription
13% didn’t understand why it was needed
Only 7.3% cited cost as a barrier
4.4% reported not knowing what naloxone is

Open‑ended responses highlighted additional themes. Some patients felt the prescription did not apply to them or associated naloxone with stigma. Others reported feeling judged or offended when offered naloxone. When asked what could improve uptake, respondents emphasized the importance of physicians clearly explaining why naloxone was prescribed, its preventative purpose, and how it could benefit them or others. Additional suggestions included respectful communication and reducing or eliminating cost barriers.

Conclusion & Discussion: When Naloxone is prescribed by a physician, 80% of patients successfully obtain it. This underscores the critical need to implement strategies that proactively identify high-risk individuals within the healthcare system and prompt physicians to prescribe Naloxone—while also ensuring patients receive clear, supportive education about its use.
This data has driven increased engagement across Kaiser Permanente markets (8), with markets regularly monitoring provider prescriptions for Naloxone, implementing an E-visit where patients can actively obtain a Naloxone order (in order to use their pharmacy benefit), and 7/8 Kaiser markets formally adopting the national Best Practice Alerts (BPAs) which when high risk patients are in the office the physician will get an alert through the electronic medical record prompting the ordering of Naloxone, which will then provide the physician relevant talking points and patient education in the after visit summary.
Additionally, we revised the BPA suppression criteria: instead of suppressing alerts based on pharmacy fill data, we now suppress them for two years following a physician’s order. This change has significantly improved physician engagement and reduced alert fatigue, fostering stronger support for BPAs among the medical groups to support ordering Naloxone for their patients, even in areas where there's robust public distribution programs.

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