Children's Hospital of Philadelphia Initiative Substantially Increases Naloxone Co-Prescribing when Outpatient Opioids Are Prescribed

Multidisciplinary initiative increased naloxone co-prescribing with outpatient opioid prescriptions from <3% to more than 80% across the health system within one year, aligning with recent recommendations by the American Academy of Pediatrics

PHILADELPHIA, July 14, 2026 /PRNewswire/ -- A multidisciplinary team at Children's Hospital of Philadelphia (CHOP) substantially increased naloxone co-prescribing for patients prescribed outpatient opioid prescriptions through an enterprise-wide quality improvement initiative designed to reduce the risk of opioid overdose. The findings, recently published by The Journal of Pediatrics, demonstrate that a standardized, electronic health record (EHR)-based approach combined with provider, pharmacist, nurse, patient, and family education can dramatically improve adherence to evidence-based opioid safety practices.

Although opioids may play a role in treating pain, they also carry the risk of accidental poisoning, misuse, and overdose. A prior CHOP study found that opioids accounted for more than half of fatal poisoning cases among children younger than five years old, while adolescents and young adults prescribed opioids are also at increased risk for overdose.

Naloxone (or Narcan) is a medicine that can save someone from opioid overdose or poisoning, and it can be administered by individuals without medical training. The U.S. Food and Drug Administration recommends that health care professionals discuss naloxone with all patients receiving opioids or medications to treat opioid use disorder, and legislation requiring naloxone co-prescription or education has been enacted in 18 states. However, guidance for prescribing naloxone to pediatric patients had been historically left out of this discussion. CHOP, through its EMPOWER Program, aims to apply a pediatric lens to combatting the overdose crisis, which led to the development of this initiative.

In 2023, less than 3% of patients who were prescribed opioids at discharge from CHOP also received a naloxone prescription. CHOP's Naloxone Co-Prescribing Initiative part of the EMPOWER program, was led by pediatric nurse practitioner Michele Bythrow, MSN, CPNP within the Department of Anesthesiology and Critical Care Medicine, and established an institution-wide quality improvement program. The goal was to increase naloxone co-prescribing to at least 80% for eligible patients discharged with outpatient opioid prescriptions.

"Without specific guidelines in place for pediatric populations at the start of this study, we saw an opportunity to replicate effective strategies that had improved naloxone co-prescribing among adult populations and adapt them for CHOP's needs," Bythrow said.

Between October 2023 and June 2025, the initiative was implemented in three phases across the health system. The team implemented an EHR-based automated alert combined with education for providers, nurses, patients and families, and pharmacists. They evaluated prescribing rates, pharmacy dispensing, provider engagement with clinical decision support tools, and barriers to medication access.

Compared with the one-year baseline period, average monthly naloxone co-prescribing increased from 3.0% to 84.1% across the enterprise. Although perceived stigma and medication costs remained barriers to dispensing, nearly 60% of prescriptions were filled through CHOP pharmacies. Surveys also demonstrated that most providers found electronic prescribing tools easy to use and reported increased comfort discussing naloxone with patients and families.

The team also partnered with CHOP's outpatient pharmacy to monitor out-of-pocket costs, identify financial barriers, and improve affordability. Their work ultimately helped expand access to a Pennsylvania state discount program previously available only to adult patients.

While this initiative focused on improving naloxone co-prescribing with an outpatient opioid prescription, the team views their work as a scalable framework for advancing safe opioid prescribing practices across pediatric health systems.

Future efforts will focus on partnering with other institutions to share implementation strategies that promote standardized, evidence-based opioid safety practices and reduce preventable opioid-related harm among children and adolescents. Improving affordability is an essential component of increasing access to this potentially lifesaving medication.

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.

About Children's Hospital of Philadelphia:
A non-profit, charitable organization, Children's Hospital of Philadelphia, was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, the hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. The institution has a well-established history of providing advanced pediatric care close to home through its CHOP Care Network, which includes more than 50 primary care practices, specialty care and surgical centers, urgent care centers, and community hospital alliances throughout Pennsylvania, New Jersey, and Delaware. CHOP also operates the Middleman Family Pavilion and its dedicated pediatric emergency department in King of Prussia, the Behavioral Health and Crisis Center (including a 24/7 Crisis Response Center) and the Center for Advanced Behavioral Healthcare, a mental health outpatient facility. Its unique family-centered care and public service programs have brought Children's Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit https://www.chop.edu.

Contact: Ben Leach
Children's Hospital of Philadelphia
(609) 634-7906
[email protected]

SOURCE Children's Hospital of Philadelphia