HHS: Prescribe naloxone to patients at high risk for opioid overdose
HHS issued new guidance today that recommends prescribing or co-prescribing naloxone and providing education about this treatment in patients at high risk for opioid overdose, according to a press release.
“We have begun to see some encouraging signs in our response to the opioid crisis, but we know that more work is required to fully reverse the decades-long epidemic,” Adm. Brett P. Giroir, MD, assistant secretary for health and senior advisor for opioid policy at HHS, said in a press release.
“Co-prescribing naloxone when a patient is considered to be at high risk of an overdose, is an essential element of our national effort to reduce overdose deaths and should be practiced widely,” he continued.
HHS data suggest less than 1% of patients to whom clinicians should consider co-prescribing naloxone actually receive a naloxone prescription. Thus, the agency recommends clinicians strongly consider prescribing or co-prescribing naloxone and providing education about its use to the following patients:
- those prescribed opioids at a daily dosage of 50 morphine milligram equivalents or more;
- those prescribed opioids who also have reported excessive alcohol use; have been prescribed benzodiazepines; have a nonopioid substance use or mental health disorder; or have a respiratory condition such as obstructive sleep apnea or COPD (regardless of opioid dose);
- those who use heroin, illicit synthetic opioids or are misusing prescription opioids;
- those who use stimulants, including cocaine and methamphetamine, which may possibly be contaminated with illicit synthetic opioids like fentanyl;
- those who receive treatment for opioid use disorder, including medication-assisted treatment with buprenorphine, naltrexone or methadone; and
- those who misused opioids in the past and were also recently released from incarceration or other controlled settings where tolerance to opioids has been lost.
HHS also recommends clinicians teach patients, their family members and friends and others who are likely to respond to an overdose on when and how to use naloxone.
The new guidelines build on recommendations released by the CDC in 2016 that were intended to increase the use of effective nonopioid treatments for chronic pain, except in cases of active cancer, palliative and end-of-life care, that were based on the following principles:
- use only when the benefits outweigh the risks and not as a first-line therapy;
- establish goals for pain and function;
- discuss risks and benefits with patients;
- use immediate-release opioids, rather than extended-release, when starting;
- use the lowest effective dosage;
- prescribe shorter durations for acute pain;
- frequently evaluate benefits and harms;
- use strategies to mitigate risk;
- review patients’ Prescription Drug Monitoring Program data;
- use urine drug testing before starting opioid therapy;
- avoid prescribing concurrent opioid and benzodiazepine treatments; and
- offer treatment for opioid use disorder.
Since the CDC released its guidelines, the HHS also unveiled a five-point strategy to combat the opioid crisis that included better addiction prevention, treatment and recovery services; better data; better pain management; better targeting of overdose reversing drugs; and better research. In addition, this past April, the Surgeon General’s office issued an advisory that encouraging more individuals, including those who are personally at risk for an opioid overdose, and their family and friends, to carry naloxone. – by Janel Miller
For more information: HHS.gov. “Naloxone: The opioid reversal drug that saves lives.”
https://www.hhs.gov/opioids/sites/default/files/2018-12/naloxone-coprescribing-guidance.pdf. Accessed Dec. 19, 2018.
Disclosure: Giroir works for HHS.