Abstract
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. To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies. 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. State legal intervention mandating naloxone coprescription. Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated. 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. 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.
Highlights
The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription
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
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
Summary
Deaths due to opioid overdose (OOD) have been continuously increasing over the past 2 decades, and this trend is predicted to continue.[1,2] From 2016 to 2017, the age-adjusted rate of drug overdose deaths increased by 9.6%, from 19.8 per 100 000 standard population in 2016 to 21.7 per 100 000 in 2017.2 Of all drug overdose deaths, approximately 68% were attributed to opioids in 2017.2 States have implemented varied approaches to prevent prescription opioid misuse, including mandatory query of prescription drug monitoring programs prior to issuing opioid analgesic prescriptions and establishing limits on the quantity and days’ supply of opioid analgesics.[3,4,5] These prescription opioid supply-side interventions, are estimated to be associated with modest decreases in overdose deaths, as recent data show that the OOD crisis is mainly driven by illicitly manufactured synthetics, such as fentanyl.[1]A widespread public health response to the OOD crisis has focused on increasing naloxone access, generally through community-based naloxone programs in which naloxone kits were distributed by local agencies free of charge.[6]. Deaths due to opioid overdose (OOD) have been continuously increasing over the past 2 decades, and this trend is predicted to continue.[1,2] From 2016 to 2017, the age-adjusted rate of drug overdose deaths increased by 9.6%, from 19.8 per 100 000 standard population in 2016 to 21.7 per 100 000 in 2017.2 Of all drug overdose deaths, approximately 68% were attributed to opioids in 2017.2 States have implemented varied approaches to prevent prescription opioid misuse, including mandatory query of prescription drug monitoring programs prior to issuing opioid analgesic prescriptions and establishing limits on the quantity and days’ supply of opioid analgesics.[3,4,5] These prescription opioid supply-side interventions, are estimated to be associated with modest decreases in overdose deaths, as recent data show that the OOD crisis is mainly driven by illicitly manufactured synthetics, such as fentanyl.[1]. In April 2018, the Office of the Surgeon General issued a public health advisory on naloxone and opioid overdose noting the limited availability of naloxone in communities and encouraged health care practitioners to play more active roles in increasing the awareness, possession, and use of naloxone.[11,12]
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