Naloxone Prescription Fills Inch Upward, But Remain Low Overall

The Centers for Disease Control and Prevention (CDC) recommends that physicians consider prescribing the opioid-overdose-reversal drug naloxone to patients at risk for opioid overdose, including those with a history of overdose or substance use disorder, those who take higher opioid dosages, and those who take both opioids and benzodiazepines. Yet less than 2% of patients in these populations fill prescriptions for naloxone, a study in the Journal of General Internal Medicine has found.

Lewei (Allison) Lin, M.D., M.S., a research investigator at the Center for Clinical Management Research at VA Ann Arbor, and colleagues examined claims data from a private health insurance database in six-month increments from January 2014 through June 2017. They compared the records of adults who received opioids and naloxone with the records of those who received only opioids, and looked at whether the risk factors for opioid overdose outlined in the CDC recommendations were associated with receiving naloxone.

By the end of the last six-month period in the study (January 2017 to June 2017), only 1.6% of patients who were taking high dosages of opioids (at least 90 morphine milligram equivalents per day) had filled a prescription for naloxone. Among those with a history of opioid overdose, only 1.6% had filled a naloxone prescription, followed by only 1.4% of those with a history of opioid use disorder. Less than 1% of those who were taking both opioids and benzodiazepines had filled a naloxone prescription.

Lin, who is also an addiction psychiatrist and assistant professor in the Department of Psychiatry at the University of Michigan Medical School, said that although dispensing rates are slowly increasing, they are still inadequate.

“There is still a lot of work to be done in getting naloxone to the patients at highest risk, especially those with a history of overdose,” she said.

In the study, Lin and her colleagues noted that they could not determine from the data whether patients had received prescriptions for naloxone but had not filled those prescriptions. However, Lin told Psychiatric News that health professionals who prescribe opioids may not know about a patient’s risk, especially if the patient has undisclosed or undiagnosed substance use disorder.

“We saw the vast majority of people who received naloxone were people also receiving opioids. In recent years, many of those at risk for overdose are no longer being prescribed opioids. In particular, this includes people who use heroin, cocaine, or crystal meth. These groups are at very high risk because these drugs are often mixed with fentanyl,” Lin said.

Lin pointed out that although psychiatrists generally do not prescribe opioid pain relievers, they work with patients with other risk factors for overdose, including patients with opioid use disorder, a history of overdose, or concurrent use of benzodiazepines.

“It’s important to look at all of these risk factors and to talk to patients about naloxone. Or, if patients tell you they have family members who struggle with addiction, a discussion of naloxone can be part of the conversation you have with them,” Lin said.

This study was supported by Precision Health at the University of Michigan, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, and the Michigan Department of Health and Human Services. Lin’s research was also supported in part by funding from the U.S. Department of Veterans Affairs Health Services Research & Development Service. ■

“Association of Opioid Overdose Risk Factors and Naloxone Prescribing in U.S. Adults” is posted here.