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New workflow to reduce opioid overdoses and deaths

02 Jun 2024

See tip sheet, starts June 11

By: Kathleen Harder, MD, associate chief medical officer for medical specialties

During the 2023 Oregon Legislature, SB 1043 (ORS441.052) was passed and integrated into the OHA discharge rules to combat the epidemic of opioid overdoses and deaths.


SB 1043 (ORS441.052) requires hospitals to provide two physical doses of an opioid overdose reversal medication upon discharge to home or other unlicensed private setting for patients who have had actively-treated opioid use disorder (OUD) during their hospital or emergency department stay. For patients with active OUD, a prescription for Narcan will not suffice. 


We have a workflow for ED discharges that satisfies the requirements of this law. The new inpatient workflow goes live June 11. A best practice advisory (BPA) will fire during discharge work for a patient who has a prior-to-admission order of methadone, Suboxone, buprenorphine or naltrexone, or who received naloxone during the hospital stay.


The BPA will ask if the patient has OUD and take the provider to the Narcan for Discharge order set, which will provide an order for a take-home pack of naloxone and add an accompanying order for the AVS. Nursing will educate and give the medication to the patient prior to discharge.


The law does not require providing an opioid reversal medication to the discharging patient if the patient leaves AMA or if the patient declines the medication.


The BPA is a reminder to order Narcan, but it will not catch every patient with OUD (for example, those using street drugs without an official diagnosis or treatment or those with a long-term prescription for opioids without a diagnosis of OUD). For these patients, consider supplying a prescription for Narcan at discharge. Additionally, for patients being discharged with opioids (for example, a post-op patient being sent home with oxycodone), please consider ordering a prescription for Narcan rather than sending a take-home pack.


Click for the Best Practice Advisory for Narcan Take Home Packs tip sheet.