PDG1 Opioid Overdose Risk Factors and Naloxone Prescribing Among Adults Enrolled in Mississippi Medicaid

Abstract

Naloxone, which is a safe, rapid-acting, and easy to use opioid antagonist medication, has become a critical tool to prevent opioid overdose deaths in recent years. The objective of this study was to describe naloxone use among patients receiving opioids enrolled in Mississippi Medicaid. A retrospective analysis was conducted using Mississippi Medicaid data from August 2018 to August 2020. Beneficiaries aged 18 and older and received opioid prescriptions were included. Receiving naloxone was defined as patients receiving any outpatient fill for a naloxone prescription. Risk factors for opioid overdose emphasized in the CDC guidelines were identified for eligible beneficiaries. A chi-square test, Fisher’s Exact test, or t-test was used to analyze differences in naloxone use among various demographic variables and risk factors. A total of 113,739 beneficiaries receiving opioids were included. Of these beneficiaries, 0.52% (597 beneficiaries) received naloxone. Beneficiaries who were between 46 and 65 years of age, African American, and covered by Magnolia health plan were more likely to receive naloxone compared with other groups (p < 0.001). Higher percentages of naloxone users had risk factors for overdose including high Morphine Equivalent Daily Dose (MEDD) use, long-term opioid use, concomitant use of benzodiazepine, concomitant use of antipsychotic, high-risk diagnosis (i.e., alcohol dependence, opioid dependence, other substance abuse dependence, and depression), and history of opioid overdose compared with non-naloxone users (p < 0.001). This study provided evidence on naloxone fills among Medicaid beneficiaries receiving opioids. The results showed that the use of naloxone was still very low, even after the emphasis of considering naloxone use for patients with risk factors in 2018. Further studies are needed to investigate the barriers contributing to the low rate of naloxone use, and interventions are needed for improving the appropriate use of naloxone.