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Certain state distribution laws for naloxone decrease fatal opioid overdoses

Although laws affecting the availability of naloxone have been passed in many states, only laws that allowed pharmacists to directly dispense naloxone significantly reduced the number of fatal opioid overdoses, according to a recent study published in JAMA Internal Medicine.

“Depending on the jurisdiction, [naloxone formulations] can be prescribed by a physician directly to patients or indirectly through standing orders, or distributed without a prescription through Overdose Education and Naloxone Distribution programs, opioid overdose prevention programs, and pharmacies in states that legally permit it,” Rahi Abouk, PhD, of the department of economics, finance and global business at William Paterson University, and colleagues wrote.

To determine what effect different naloxone access laws had on opioid overdoses, researchers compared fatal and nonfatal overdoses in states with and without legislation governing naloxone. Researchers reviewed laws that gave pharmacists direct authority to prescribe naloxone, those that provided indirect authority to prescribe, and other types of access.

Researchers used 2010 to 2016 State Drug Utilization Data on outpatient drugs paid for by state Medicaid and Medicaid managed-care organizations. The National Center for Health Statistic’s National Vital Statistics System for 2005 to 2016 was used to collect data on opioid-related mortality.

The primary outcome was fatal overdoses that involved opioids and secondary outcomes were Medicaid naloxone prescriptions and nonfatal overdoses that resulted in ED visits.

Researchers found that laws that gave pharmacists direct authority to dispense naloxone were associated with a significant decrease in fatal overdoses. In addition, they experienced a significant increase in nonfatal overdoses treated during ED visits. Overall, researchers estimated that direct dispensing naloxone laws reduced fatal overdoses by 0.387 (95% CI, 0.119-0.656) per 100,000 people 3 or more years after being adopted.

Researchers found little evidence that laws that gave pharmacists indirect authority to dispense naloxone or supported other means of access were associated with a decrease in fatal overdoses.

“These results highlight the importance of coupling naloxone laws with useful interventions and connections to treatment for patients seen in EDs for overdoses, as this is the location where such programs may be most effective,” Abouk and colleagues wrote. – by Erin Michael

Disclosures: Abouk reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.