The US Centers for Disease Control’s 2016 Guideline for Prescribing Opioids for Chronic Pain recommends that clinicians consider co-prescribing naloxone when they prescribe opioids to patients with known opioid overdose risks factors.* This retrospective observational study used a national insurance claims database to determine patient-level factors associated with receiving naloxone co-prescribed with an opioid, and changes in co-prescribing prevalence over the study period (2014–2017).
- Among 4.3 million adult patients with continuous insurance coverage who filled an opioid prescription, 3980 were co-prescribed naloxone.
- Compared with patients receiving <50 mg of morphine equivalents (MME) daily, patients receiving high-dose opioids (≥90 MME) had nearly four times greater odds of receiving naloxone co-prescriptions (adjusted odds ratio [aOR], 3.94).
- Naloxone co-prescription was also associated with receiving a concurrent benzodiazepine prescription (aOR, 1.27) and having opioid use disorder (aOR, 1.56).
- Prior opioid overdose was NOT associated with naloxone co-prescription.
- The prevalence of naloxone co-prescribing increased over the study period, but remained <2% among patients with overdose risk factors.
* Defined as people with: a prior opioid overdose, opioid use disorder, co-prescription of a benzodiazepine, or a prescription for high-dose opioid medication.
Comments: This study highlights missed opportunities to get naloxone into the hands of people who are at risk for opioid overdose. Community-based overdose education and naloxone distribution programs are another important source of naloxone; however, clinicians should be discussing the risk of overdose with patients to whom they prescribe opioids, and co-prescribing naloxone can be a strategy for mitigating risk.
Aaron D. Fox, MD
Reference: Lin LA, Brummett CM, Waljee JF, et al. Association of opioid overdose risk factors and naloxone prescribing in US adults. J Gen Intern Med. 2020;35(2):420–427.