Naloxone is underprescribed to high-risk patients, CDC says

Naloxone prescriptions more than doubled between 2017 and 2018 but still only one in 69 patients receiving high-dose opioids gets a naloxone prescription.

Too few doctors are prescribing naloxone to patients who are taking high-dose opioids (≥50 morphine milligram equivalents per day) or opioids plus benzodiazepines or who have a substance use disorder, according to recent CDC data.

The agency analyzed 2012–2018 retail pharmacy data to assess U.S. naloxone dispensing by U.S. Census region, urban/rural status, prescriber specialty, and patient age, sex, copayments, and method of payment. Factors associated with naloxone dispensing at the county level were also examined. Results were published Aug. 6 in MMWR.

In 2018, naloxone dispensing rates were 187.7 per 100,000 women and 151.6 per 100,000 men. Dispensing was higher for people ages 60 to 64 years (362.8) than for any other age group. Rates of dispensed naloxone prescriptions were highest among those with commercial insurance (51.1%), followed by Medicare (35.9%), Medicaid (10.7%), and self-pay (2.4%). Overall, 42.3% of prescriptions did not require out-of-pocket costs. Among the rest, 24.5% had copays less than $10, 21.9% were $10 to $50, and 5.8% were more than $50.

From 2017 to 2018, the number of high-dose opioid prescriptions decreased 21%, from 48.6 million to 38.4 million, while naloxone prescriptions increased 106%, from 270,710 to 556,847. In 2018, an estimated 9 million patients were given a high-dose opioid prescription, and 406,203 were prescribed naloxone. The researchers calculated that only one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions nationwide.

Naloxone prescriptions per 100 high-dose opioid prescriptions increased 150% from 2017 (0.6) to 2018 (1.5), varying widely by prescriber specialty. In 2018, naloxone prescriptions per 100 high-dose opioid prescriptions were lowest from surgeons (0.2), pain medicine physicians (1.3), physician assistants (1.3), primary care physicians (1.5), and nurse practitioners (2.3). Psychiatrists had the highest rate of naloxone prescriptions dispensed for every 100 high-dose opioid prescriptions (12.9), followed by addiction medicine specialists (12.2) and pediatricians (10.4).

The study also found substantial regional variation in naloxone dispensing, from an average of 16.2 per 100,000 population in the lowest quartile to 410.0 in the highest quartile, with the lowest rates in the most rural counties. Additional efforts are needed to improve naloxone access at the local level, the study authors wrote. They also noted that the variation in dispensing of naloxone occurs despite consistent state laws.

“Naloxone distribution is an important component of the public health response to the opioid overdose epidemic,” the authors wrote. “Health care providers can prescribe or dispense naloxone when overdose risk factors are present and counsel patients on how to use it.”