Naloxone Prescriptions Among Commercially Insured Individuals at High Risk of Opioid Overdose (original) (raw)
Related papers
Drug Safety, 2020
Introduction Clinical practice guidelines recommend co-prescribing naloxone to patients at high risk of opioid overdose, but few such patients receive naloxone. High costs of naloxone may contribute to limited dispensing. Objective The aim of this study was to evaluate rates and costs of dispensing naloxone to patients receiving opioid prescriptions and at high risk for opioid overdose. Methods Using claims data from a large US commercial insurance company, we conducted a retrospective cohort study of new opioid initiators between January 2014 and December 2018. We identified patients at high risk for overdose defined as a diagnosis of opioid use disorder, prior overdose, an opioid prescription of ≥ 50 mg morphine equivalents/day for ≥ 90 days, and/or concurrent benzodiazepine prescriptions. Results Among 5,292,098 new opioid initiators, 616,444 (12%) met criteria for high risk of overdose during follow-up, and, of those, 3096 (0.5%) were dispensed naloxone. The average copayment was US$24.83 for naloxone (standard deviation [SD] 67.66) versus US$9.74 for the index opioid (SD 19.75). The average deductible was US$6.18 for naloxone (SD 27.32) versus US$3.74 for the index opioid (SD 25.56), with 94% and 88% having deductibles of US$0 for their naloxone and opioid prescriptions, respectively. The average out-of-pocket cost was US$31.01 for naloxone (SD 73.64) versus US$13.48 for the index opioid (SD 34.95). Conclusions Rates of dispensing naloxone to high risk patients were extremely low, and prescription costs varied greatly. Since improving naloxone's affordability may increase access, whether naloxone's high cost is associated with low dispensing rates should be evaluated.
Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2003
Preliminary research suggests that naloxone (Narcan), a short-acting opiate antagonist, could be provided by prescription or distribution to heroin users to reduce the likelihood of fatality from overdose. We conducted a random postal survey of 1,100 prescription-authorized health care providers in New York City to determine willingness to prescribe naloxone to patients at risk of an opiate overdose. Among 363 nurse practitioners, physicians, and physician assistants responding, 33.4% would consider prescribing naloxone, and 29.4% were unsure. This preliminary study suggests that a substantial number of New York City health care providers would prescribe naloxone for opiate overdose prevention.
The state of naloxone: Access amid a public health crisis
Medicine Access @ Point of Care
Over the past decade, opioid use has been at the forefront of a public health crisis throughout the United States. In response to the tremendous negative societal, personal, and economic impacts that the growing opioid crisis has caused, several governmental agencies began to respond. These efforts include declaration of a nationwide public health emergency, increased public health surveillance of the epidemic, research support for pain and addiction, and increased access to overdose-reversing drugs such as naloxone. Naloxone access, in particular, has become a priority. In the United States, pharmacists have had the opportunity to play a crucial role in promoting access to naloxone. Since initial approval by the Food and Drug Administration (FDA) in 1971 as an antidote to opioid agonist overdose, naloxone access has evolved significantly. Today many states have authorized standing orders for naloxone, allowing it to be dispensed by pharmacists without a patient-specific prescriptio...
JAMA Network Open, 2019
IMPORTANCE To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients. OBJECTIVE To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies. DESIGN, SETTING, AND PARTICIPANTS This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA's national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month and the study period was January 1, 2011, to December 31, 2017. EXPOSURES State legal intervention mandating naloxone coprescription. MAIN OUTCOMES AND MEASURES Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated. RESULTS The rate of naloxone dispensing increased after implementation of legal mandates for naloxone coprescription. An estimated 88 naloxone prescriptions per 100 000 were dispensed in Virginia and 111 prescriptions per 100 000 were dispensed in Vermont during the first full month the legal requirement was effective. In comparison, 16 naloxone prescriptions per 100 000 were dispensed in the 10 states (including the District of Columbia) with the highest opioid overdose death rates and 6 prescriptions per 100 000 were dispensed in the 39 remaining states. The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22-49.35). Implementation of the naloxone coprescription mandate was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates, holding all other variables constant. Among covariates, naloxone access laws (IRR, 1.37; 1.05-1.78), opioid overdose death rates (IRR, 1.06; 95% CI, 1.04-1.08), the percentage of naloxone prescriptions paid by third-party payers (IRR 1.009; 1.008-1.010), and time (IRR, 1.06; 95% CI, 1.05-1.07) were significantly associated with naloxone prescription dispensing. CONCLUSIONS AND RELEVANCE These study findings suggest that legally mandated naloxone prescription for those at risk for opioid overdose may be associated with substantial increases in naloxone dispensing and further reduction in opioid-related harm.
Journal of Urban Health, 2007
Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a "take-home" dose of naloxone. Under current FDA regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs.
Opioid Prescribing with Take-Home Naloxone: Rationale and Recommendations
Current Anesthesiology Reports, 2020
Purpose of Review Although take-home naloxone is available for prescribing, recommended for certain high-risk patients, and can prevent overdose-related deaths, access to naloxone remains a challenge. This review describes the high-risk population on opioids that benefit from naloxone co-prescription, guidelines, and the current trends in naloxone prescribing, and the barriers faced by all the stakeholders. Recent Findings Opioid-related overdoses and deaths still occur at critically high numbers. Short-acting opioid antagonists like naloxone can reverse the effect of an overdose in a few minutes. The US Food and Drug Administration (FDA) approved naloxone nasal spray, and auto-injectable kits are both effective and easy to administer. An increasing number of states in the USA mandate the co-prescription of naloxone for patients on chronic opioid therapy, irrespective of the presence of other underlying risk factors. The lack of provider education is one of the significant barriers for co-prescribing naloxone with opioids. Summary Naloxone can be lifesaving in patients experiencing an opioid overdose. Providers are encouraged to co-prescribe take-home naloxone for high-risk patients on chronic opioid therapy. Understanding the barriers, creating awareness, and providing education can increase the prescription of take-home naloxone and help prevent opioid overdose-related deaths.
The Effect of Naloxone Access Laws on Fatal Synthetic Opioid Overdose Fatality Rates
Journal of Primary Care & Community Health, 2023
Background: Increases in fatal synthetic opioid overdoses over the past 8 years have left states scrambling for effective means to curtail these deaths. Many states have implemented policies and increased service capacity to address this rise. To better understand the effectiveness of policy level interventions we estimated the impact of the presence of naloxone access laws (NALs) on synthetic opioid fatalities at the state level. Methods: A multivariable longitudinal linear mixed model with a random intercept was used to determine the relationship between the presence of NALs and synthetic opioid overdose death rates, while controlling for, Good Samaritan laws, opioid prescription rate, and capacity for medication for opioid use disorder (MOUD), utilizing a quadratic time trajectory. Data for the study was collected from the National Vital Statistics System using multiple cause-of-death mortality files linked to drug overdose deaths. Results: The presence of an NAL had a significant (univariate P-value = .013; multivariable p-value = .010) negative relationship to fentanyl overdose death rates. Other significant controlling variables were quadratic time (univariate and multivariable P-value < .001), MOUD (univariate P-value < .001; multivariable P-value = .009), and Good Samaritan Law (univariate P-value = .033; multivariable P-value = .018). Conclusion: Naloxone standing orders are strongly related to fatal synthetic opioid overdose reduction. The effect of NALs, MOUD treatment capacity, and Good Samaritan laws all significantly influenced the synthetic opioid overdose death rate. The use of naloxone should be a central part of any state strategy to reduce overdose death rate.
Naloxone Availability in Community Pharmacies, 2019
2021
Background: Increasing the availability of naloxone among friends and family of past and present opioid users is a vitally important mission to reduce the occurrence of opioid-related overdose deaths. The purpose of this study was to determine the availability of naloxone in independent pharmacies in Georgia. Secondary objectives include determining pharmacists’ knowledge regarding the standing order and ability to counsel regarding naloxone.Methods: A cross-sectional study was conducted over a period of ten months. The study was population based and was conducted at all independent pharmacies in the state of Georgia. All independent pharmacies in the state of Georgia were contacted and asked the below questions with a 96% response rate (n=520). Results: 558 independent, retail pharmacies were called, with a 96% response rate (n=520 pharmacies). Two hundred-twenty pharmacies reported having naloxone in stock. Of the 335 pharmacists asked, 174 (51.9%) incorrectly said that a prescrip...
Trends in Filled Naloxone Prescriptions Before and During the COVID-19 Pandemic in the United States
JAMA Health Forum
, less than all prescriptions and much less than naloxone prescriptions. Limitations of this study include that we are only able to account for naloxone prescriptions filled at retail pharmacies and not naloxone kits distributed from other sources, such as syringe service programs. 6 Our study identifies an urgent gap in necessary access to medication for individuals on Medicare and commercial insurance during the pandemic. Continuing to increase naloxone distribution in densely populated areas and via mail order and delivery through community-based organizations could help to mitigate some of the reductions in naloxone distribution via pharmacies and could reduce some of the increases in fatal opioid overdoses during the COVID-19 pandemic.