Study recommends clinicians co-prescribe naloxone to reduce opioid deaths

Study recommends clinicians co-prescribe naloxone to reduce opioid deaths

A new study on the benefits of naloxone argues the opioid overdose treatment drug should be co-prescribed with opioid medications, but should not be available over-the-counter.

The study, “A Way Forward: How Naloxone Saves Lives from Overdoses” published by CME Outfitters, a continuing medical education organization, suggests that co-prescribing naloxone is not only a life-saving measure for those with opioid use disorder (OUD) but a way for prescribers to talk to patients about the risk of accidental overdose.

“It is obvious, logical and well-reasoned to increase naloxone availability in emergency departments, ambulances, and among emergency medical technicians (EMTs), as they routinely encounter opioid overdose,” the study said. “However, improving naloxone access at other points of care where overdose risk is likely, remains a challenge. A good place to start is by encouraging all patients with OUD to carry naloxone, and for their homes to have naloxone nearby in the bedroom or bathroom.”

The study even suggested that current and past OUD patients, and their friends and family, are at high risk of overdosing and should have naloxone nearby at all times.

“I think that this is not just about getting naloxone in the hand of the people who need it, but it’s an important education point between doctor and patient to talk about the risks associated with prescription opioids,” said Jessica Hulsey Nickle, founder of the patient advocacy group Addiction Policy Forum. “It’s a time to discuss if there’s continued use or any concerns from the patient or even the physician.”

Having that access is even more necessary right now, Nickle said during the current pandemic.

“Really we are still in a very serious opioid crisis,” she said. “With the COVID-19 pandemic, overdoses are going up and not down. I do not see a downside to having both increase access to naloxone and secondarily that conversation and engagement between physician and patient.”

But the study recommends not making naloxone an over-the-counter (OTC) medication.

While easier to access as an OTC, making naloxone available without a prescription could actually decrease patients’ ability to get the drug. Once available as OTC, the drug may be priced out of reach for some patients if it becomes available as an over-the-counter medication, currently covered by low to no co-pay.

“These reimbursement options would become unavailable with over-the-counter distribution strategies if appropriate actions are not taken to support patients who need naloxone desperately,” the study said.

Ensuring that patients get the overdose-reversing drug in connection to physician supervision is also an important step in treating OUD.

“OUD is a deadly illness. Naloxone is a life-saving medication in the event of an overdose but not a treatment for an underlying OUD. It is critical for those struggling with an OUD to be connected to a health professional,” said Brian Fuehrlein, associate professor of psychiatry at the Yale University School of Medicine. “The widespread availability of naloxone, while saving lives acutely, has the unwarranted effect of reducing the need for connecting with healthcare professionals. Many people believe that as long as they have naloxone available, that is sufficient. There is also a need for medication for addiction treatment and psychosocial support programs for recovery.”

While progress has been made in making naloxone more readily available, there is still much to do, the study panelists said.

Currently, nine states — Arizona, California, Florida, New Mexico, Ohio, Rhode Island, Vermont, Virginia, and Washington — all have put in place legislation requiring co-prescription of naloxone with high-risk opioids. But, more should be done to improve patients’ understanding of the risks of opioid use, and the risk of accidental overdose.

Researchers pointed to a naloxone distribution program in Massachusetts that reduced opioid overdose death, without increasing opioid use, by an estimated 11 percent in the 19 communities that implemented the program.

Dr. Steven Stanos, medical director for Swedish Health System Pain Medicine and Services in Seattle, said that more than 75 percent of opioid deaths occur outside of a clinical setting, but only 5 percent of people prescribed opioids receive a co-prescription for naloxone.

Treating that discrepancy – through education and tailored messages to reach different segments of the population, as well as reducing the stigma surrounding pain management and opioid use – is the best way to effectively get naloxone into the hands of the patients that need it, Nickle said.

And giving them naloxone to use at home doesn’t decrease the likelihood of patients seeking treatment for OUD, she said.

“The best case scenario is that we get naloxone with educational materials to patients to talk to them about how to seek help,” Nickle said. “We encourage all of our families and patients and their network to immediately seek medical attention after an overdose, especially if it is reversed in the home. The point is, we can’t save the life and get them into treatment if we don’t save the life first.”