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Naloxone coprescription laws may lead to more than 7-fold increase in dispensing

Legally mandating naloxone coprescriptions for patients at high risk for opioid overdose was tied to a 7.75-fold increase in dispensed naloxone prescriptions, according to study results published in JAMA Network Open.

The findings suggest that legal mandates for naloxone coprescription could improve naloxone availability and reduce opioid-related harm such as overdose, according to study authors.

“Since 2010, states have made legal changes aimed at expanding access to naloxone and increasing its use by laypersons,” Minji Sohn, PhD, of the College of Pharmacy at Ferris State University, and colleagues wrote. “For example, as of 2017, 49 states and the District of Columbia had enacted a naloxone access law authorizing pharmacists to dispense or distribute naloxone without a patient-specific prescription from another medical professional. However, recent data show that, despite these legal interventions, overall naloxone dispensing remains low.”

“In 2017, Virginia and Vermont became the first 2 states to mandate naloxone coprescription to opioid-receiving patients who have risk factors of [opioid overdose],” they continued.

Researchers evaluated the associations between legally mandated interventions that required naloxone coprescription and naloxone distributions in a population-based, state-level observational cohort study. Data for the study were collected from the IQVIA national prescription audit, which included all naloxone prescription transactions in 90% of U.S. retail pharmacies each month per state from Jan. 1, 2011, to Dec. 31, 2017.

In the first month after coprescription was legally required, Virginia had 88 naloxone prescriptions dispensed per 100,000 standard population and Vermont had 111 prescriptions per 100,000 dispensed. In states without coprescription mandates, 16 naloxone prescriptions per 100,000 were dispensed in the 10 states with the highest rates of opioid overdose death, and six prescriptions per 100,000 in the remaining 39 states during the same month.

Using a regression model, researchers found that legal mandates for naloxone coprescription were associated with 7.75 times more dispensed naloxone (95% CI, 1.22-49.35), which equated to 214 more naloxone prescriptions dispensed per month.

Naloxone prescription dispensing was also significantly associated with naloxone access laws (IRR = 1.37; 1.05-1.78), opioid overdose death rates (IRR = 1.06; 95% CI, 1.04-1.08) and the percentage of naloxone prescriptions paid by third party payers (IRR = 1.009; 1.008-1.01).

“Although this study and others have shown these provisions to increase naloxone access, additional efforts are needed if we are to meet the U.S. Surgeon General’s goal of broadening the availability and use of naloxone to reduce [opioid overdose] mortality,” Sohn and colleagues wrote. “Our study findings suggest that legally mandated naloxone prescription for persons at risk for [opioid overdose] may increase naloxone dispensing and further reduce harm and save lives.” – by Erin Michael

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