CDC: Not enough doctors prescribing naloxone
Naloxone prescription rates have improved, but there were many “missed opportunities” to potentially avoid opioid-overdose related deaths, new CDC data show.
The data prompted officials from the CDC and HHS to encourage physicians, pharmacists and others to work together to boost naloxone prescription rates even higher.
“Our report has both good news and bad news related to opioid prescribing and co-prescribing of naloxone,” Anne Schuchat, MD, principal deputy director, CDC, said in a conference call with reporters.
“We are making progress in reducing high-dose opioid prescribing, but there is still too much. We are seeing significant increases in pharmacy prescriptions for naloxone, but there is much room for improvement,” she continued.
The appeal came after a new CDC Vital Signs report that analyzed retail pharmacy data over a 6-year period found that there was only one naloxone prescription dispensed for every 69 high-dose opioid prescriptions nationwide.
Other findings included:
- The number of high-dose opioid prescriptions decreased from 48.6 million in 2017 to 38.4 million in 2018.
- The number of naloxone distributed from retail pharmacies increased substantially from 1,282 prescriptions (0.4 per 100,000 people) in 2012 to 556,847 (170.2 per 100,000 people) in 2018.
- Nearly 9 million more naloxone prescriptions could have been dispensed in 2018 if every patient with a high-dose opioid prescription were offered naloxone.
- Rural counties — historically considered the bullseye of the opioid epidemic — were almost three times more likely to be a low-dispensing naloxone county vs. metropolitan counties.
- Naloxone dispensing was 25 times greater in the highest-dispensing counties than the lowest-dispensing counties.
- 71% of Medicare prescriptions for naloxone required a copay vs. 42% of identical prescriptions that would be covered by commercial insurance.
“It is clear from the data that there is still much needed education around the important role naloxone plays in reducing overdose deaths. The time is now to ensure all individuals who are prescribed high-dose opioids also receive naloxone as a potential life-saving intervention,” Robert R. Redfield, MD, CDC director, said in a press release.
Schuchat added that that previously released HHS guidance and the Surgeon General’s advisory on naloxone corroborates and supplements the CDC recommendations that physicians should be using to reverse the negative trends found in the report.
The CDC recommends that “clinicians should consider offering naloxone, re-evaluating patients more frequently and referring to pain and/or behavioral health specialists when factors that increase risk for harm, such as history of overdose, history of substance use disorder, higher dosages of opioids (50 or more morphine equivalents per day), and concurrent use of benzodiazepines with opioids, are present.”
The idea of teamwork to increase naloxone prescriptions both inside and outside the medical community was also discussed during the call and press release.
“Health care providers ... can learn more about how to best communicate with patients about overdose risk and the use of naloxone by participating in virtual mentoring, academic detailing and other training on naloxone prescribing and dispensing. Improving pharmacy dispensing is [another] key component of greater distribution of naloxone,” Schuchat said
Alex Azar, HHS Secretary, also encouraged collaboration.
“With help from Congress, the private sector, state and local governments, and communities, targeted access to naloxone has expanded dramatically over the last several years, but today’s CDC report is a reminder that there is much more all of us need to do to save lives,” he said in the press release
The CDC outlined additional roles it said other entities must play to reverse the trends identified in the Vital Signs report.
“Health insurers can reduce out-of-pocket costs for patients and cover naloxone prescriptions without prior approval. States and communities can support health care providers by expanding naloxone access and helping to reduce the stigma of prescribing, dispensing, and carrying naloxone,” the agency indicated in a press release. – by Janel Miller
Disclosures : Healio Primary Care was unable to determine relevant financial disclosures prior to this story’s posting.