09 Aug CDC: More Naloxone Prescriptions Needed esp in Rural Areas

MedicalResearch.com Interview with:

Dr. Gery Guy

Gery P. Guy Jr., PhD, MPH
Senior Health Economist
Division of Unintentional Injury Prevention
CDC 

MedicalResearch.com: What is the background for this study?

Response: In 2017, among the 70,237 drug overdose deaths in the United States, 47,600 (67.8%) involved prescription or illicit opioids. Distribution of the opioid receptor antagonist naloxone to reverse overdose is a key part of the public health response to the opioid overdose epidemic. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommended clinicians consider offering naloxone when overdose risk factors, such as history of overdose or opioid use disorder, higher opioid dosages, or concurrent benzodiazepine use, are present.

However, recent analyses examining pharmacy-based naloxone dispensing are lacking. To address this gap and to inform future overdose prevention and response efforts, CDC examined trends and characteristics of naloxone dispensed from retail pharmacies at the national and county level in the United States.

MedicalResearch.com: What are the main findings?

Response: Key findings of the report include:

• The number of naloxone prescriptions increased substantially from 2012 to 2018, including a doubling from 2017 to 2018.
• Only one naloxone prescription is dispensed for every 69 high-dose opioid prescriptions nationwide.
• The number of naloxone prescriptions dispensed for every high-dose opioid prescription was low among specialties that frequently prescribe high-dose opioids, such as primary care clinicians and pain medicine physicians, compared to other specialties such as addiction medicine and psychiatry.
• Most (71%) Medicare prescriptions for naloxone required a copay, compared to 42% for commercial insurance.
• Naloxone dispensing is 25 times greater in the highest dispensing counties than the lowest dispensing counties.
• Rural counties were nearly 3 times more likely to be a low dispensing county compared to metropolitan counties.

MedicalResearch.com: Is this for Naloxone dispensed without a prescription?

Response: The study included naloxone prescriptions dispensed by pharmacies either through standing order or through clinician prescription. Other channels such as community-based harm reduction efforts were not captured.

MedicalResearch.com: What should readers take away from your report?

Response: Despite progress, more prescribing and dispensing of naloxone is needed, especially in rural areas. Improved pharmacy distribution of naloxone can save lives. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our analysis was unable to examine the impact of recent state polices, such as laws requiring co-prescribing of naloxone, on pharmacy-based dispensing. Future research could examine the impact of these laws on pharmacy-based distribution of naloxone and opioid-related overdoses.

MedicalResearch.com: Is there anything else you would like to add?

Response: Comprehensively addressing the opioid overdose epidemic will require efforts to improve naloxone access and distribution in tandem with efforts to prevent initiation of opioid misuse, improve opioid prescribing, implement harm reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships. 

Citation:

Guy GP Jr., Haegerich TM, Evans ME, Losby JL, Young R, Jones CM. Vital Signs: Pharmacy-Based Naloxone Dispensing — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2019;68:679–686. DOI: http://dx.doi.org/10.15585/mmwr.mm6831e1external icon.

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Last Updated on August 9, 2019 by Marie Benz MD FAAD