Provision of Naloxone with Opioid Analgesic Prescriptions Not Associated with Increased Opioid-related Risk Behaviors

Concerns that possessing naloxone could promote riskier opioid use may prevent clinicians and pharmacists from prescribing or dispensing naloxone along with opioid analgesics. Investigators randomized 7 pharmacies within a safety-net health system to implement a naloxone co-dispensing intervention, which included patient education and new screening and naloxone dispensing workflows, or to continue standard protocols, which included standing orders for naloxone. Outcomes were assessed among patients (N=768) filling long-term opioid prescriptions and a subset of participants (n=335) who completed surveys and urine drug testing to assess risk behaviors for unhealthy opioid use.

  • Patients using intervention pharmacies were significantly more likely to receive naloxone (52% versus 14%; adjusted risk ratio [aRR], 3.38).
  • The proportion of participants in each group that reported ≥1 opioid-related risk behaviors at 8 months follow-up did not significantly differ (38% versus 35%; aRR, 1.07).
  • Risky drinking, tobacco use, other drug use, and opioid-related overdoses were not significantly different between groups.

Comments: Theories about “risk compensation” have been used as an argument against many effective health interventions, such as syringe services programs or HIV pre-exposure prophylaxis. This study shows that simple changes to pharmacy workflows and staff trainings resulted in large increases in naloxone dispensing without detectable differences in patients’ opioid-related risk behaviors. Greater naloxone distribution is urgently needed.

Aaron D. Fox, MD

Reference: Binswanger IA, Rinehart D, Mueller SR, et al. Naloxone co-dispensing with opioids: a cluster randomized pragmatic trial. J Gen Intern Med. 2022;10.1007/s11606-021-07356-6.

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