While prescriptions for naloxone have increased markedly in recent years, researchers at the CDC report that the overdose reversal drug is not prescribed enough in many areas of the country that need it most. Further, the agency reports that too few physicians are prescribing naloxone in accordance with the CDC’s Guideline for Prescribing Opioids for Chronic Pain.1

During a media briefing on the subject on Aug. 6, Anne Schuchat, MD, the CDC’s principal deputy director, noted that there are many missed opportunities to implement techniques at the local level to provide naloxone to patients at risk of overdose.

“Pharmacists and other healthcare providers play a critical role in ensuring that patients receive naloxone,” she explained. “The CDC Guideline for Prescribing Opioids for Chronic Pain recommends that that healthcare providers consider prescribing or dispensing naloxone to patients at risk for overdose. These risk factors include taking high daily dosages of prescription opioids, using benzodiazepines concurrently with opioids, and having a history of substance use disorder.”

Schuchat also noted that because of the increasing availability of highly potent opioids such as illegally made fentanyl, guidance on naloxone prescribing from the Department of Health and Human Services also recommends that naloxone be considered for people who are misusing prescription opioids, heroin, or other illicit drugs like cocaine or methamphetamine that might be contaminated with fentanyl.2

Data show that while prescriptions for naloxone doubled from 2017 to 2018, the number of naloxone prescriptions per every high-dose opioid prescription remained low, with only one naloxone prescription dispensed for every 70 high-dose opioid prescriptions, Schuchat reported. She also noted that naloxone-prescribing practices varied substantially across the country. For instance, rural counties were nearly three times more likely to be low prescribers vs. metropolitan counties.

Further, pharmacies in one out of every 12 counties dispensed high-dose opioids but did not dispense naloxone, Schuchat said. “If each person with a high-dose opioid prescription were offered naloxone, nearly 9 million prescriptions for naloxone could have been dispensed in 2018,” she noted.

Schuchat stressed the important role healthcare providers play in educating patients, caregivers, and the community about the benefits of making naloxone readily available. She also encouraged providers to consider seeking more training on how to most effectively communicate with patients about both the risk of overdose and how to use naloxone. For emergency providers in particular, the CDC is offering new guidance on what steps they can take to further address the opioid epidemic, including providing naloxone to patients at risk of overdose.3

“On average, 130 Americans die every day from an opioid overdose,” Schuchat said. “We must do a better job getting naloxone in the hands of the people who really need it and those likely to be nearby when an overdose occurs.”

REFERENCES

  1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep 2016;65:1-49.
  2. U.S. Department of Health and Human Services. How to respond to an opioid overdose. Available at: http://bit.ly/2lu6dZC. Accessed Sept. 3, 2019.
  3. Houry D, Adams J. Emergency physicians and opioid overdoses: A call to aid. Ann Emerg Med 2019;74:436-438.