#USA #Philadelphia #Children's Hospital #Naloxone #Opioids

Introduction

In a groundbreaking initiative, the Children's Hospital of Philadelphia (CHOP) has successfully enhanced naloxone co-prescribing for its outpatient opioid patients, dramatically increasing the co-prescribing rate from a mere 3% to over 80% within a year. This collaborative effort involved a coordinated approach and is a part of CHOP’s broader commitment to address the opioid crisis, particularly among youngsters.

The Naloxone Initiative

Naloxone, known commonly as Narcan, is a crucial medication that can reverse the effects of an opioid overdose. It can be administered by anyone, regardless of medical training, making it a vital tool in preventing fatalities associated with opioid overdose, which has unfortunately become a rising concern. The initiative developed by CHOP aimed to implement a systematic process for prescribing naloxone alongside opioid medication, especially as concerns about misuse and accidental overdoses continue to grow.

In 2023, only 3% of patients prescribed opioids at CHOP also received naloxone prescriptions at the time of their discharge. To combat this alarming figure, CHOP's Naloxone Co-Prescribing Initiative, led by Michele Bythrow, a pediatric nurse practitioner, was introduced under the framework of the EMPOWER Program. The aim was not only to increase the co-prescribing of naloxone but also to enhance overall opioid safety practices across their healthcare system.

Implementation Phases

The initiative unfolded in three distinct phases between October 2023 and June 2025, utilizing an electronic health record (EHR)-based automated alert system. Alongside this, significant educational efforts were made aimed at providers, nurses, patients, families, and pharmacists. This comprehensive educational outreach was necessary to ensure that everyone involved was well informed about the importance of naloxone in opioid therapy.

Results Achieved

The outcome of this initiative was significant. By the end of the implementation period, naloxone co-prescribing surged from 3.0% to an impressive 84.1% on average monthly. Despite facing challenges, such as stigma associated with naloxone and the costs of the medication, nearly 60% of the naloxone prescriptions were filled through CHOP’s own pharmacies, showcasing the initiative’s effectiveness. Feedback from healthcare providers indicated that the electronic tools provided made it easier to discuss naloxone with patients and families.

Collaborative Efforts for Broader Impact

An integral component of the initiative's success was the partnership with CHOP’s outpatient pharmacy, which focused on monitoring costs and identifying financial barriers to naloxone access. Importantly, the scope of this program extends beyond CHOP itself, as they aim to share their successful strategies with other pediatric healthcare systems. Increased access and affordability of naloxone is seen as a crucial step in promoting safety and combating the opioid crisis throughout the larger community.

Conclusion

Through the strategic initiative launched by the Children's Hospital of Philadelphia, there has been a remarkable transformation in naloxone co-prescribing practices for outpatient opioid therapy. The significant increase in prescriptions reflects a broader commitment to ensuring patient safety and addressing the risks associated with opioid medications among children and adolescents. Future endeavors will focus on extending this framework of safe opioid prescribing practices to other healthcare institutions, thereby contributing to the reduction of opioid-related harms and improving health outcomes for vulnerable populations.

For further details on naloxone co-prescribing and the practices employed, please refer to the study published in The Journal of Pediatrics: Bythrow et al, "Naloxone Co-Prescribing Across a Pediatric Health System A Quality Improvement Initiative." J Pediatr. Online June 16, 2026. DOI 10.1016/j.jpeds.2026.115199.