Opiate Overdose

Nationally, drug overdose deaths increased 11.4% from 2014 to 2015. Of the more than 52 000 drug overdose deaths in 2015, more than 60% involved opioids. Naloxone, an opioid antagonist, is effective at reversing potentially fatal respiratory depression in individuals who have overdosed. But naloxone is easy to use, safe, and cost-effective.

Naloxone training and distribution have been provided since 1996 through community-based overdose education and naloxone distribution programs, such as harm-reduction organizations. Although these programs can be highly effective in reaching at-risk populations, including peers and bystanders of people who overdose, availability of such services is not widespread.

To expand access through health care settings, both federal and state-level efforts have provided guidance and recommendations regarding increasing naloxone awareness, education, and prescribing. Such efforts include the White House Turn the Tide campaign in 2016 and the Surgeon General’s Advisory on Naloxone and Opioid Overdose.

Opioid use disorder

The Centers for Disease Control and Prevention and the Federation of State Medical Boards have established guidelines for prescribing naloxone to patients considered at high risk of dying of a future overdose, including individuals with a history of opioid use disorder or prior opioid overdose and people who have been prescribed high doses of opioids for chronic pain.

But patients at high risk of opioid overdose rarely receive prescriptions for naloxone; despite many interactions with the health care system, according to a study published online in JAMA Network Open. Sarah Follman, from the University of Chicago, and colleagues used data from Truven Health MarketScan; but (Oct. 1, 2015, through Dec. 31, 2016) to identify commercially insured patients (≥15 years) with claims related to opioid use; misuse, dependence, and overdose.

The researchers found that among the 138,108 high-risk individuals (52.4% men); 1.5% were prescribe naloxone. There was a greater likelihood of receiving naloxone among those patients; with prior diagnoses of both opioid misuse or dependence and overdose (odds ratio [OR], 2.32); versus patients with a prior diagnosis of opioid misuse or dependence without overdose.

Diagnosis of opioid misuse or dependence

A prior diagnosis of opioid overdose alone was associate with a decrease likelihood of receiving naloxone; (OR, 0.73) versus a prior diagnosis of opioid misuse or dependence without overdose. Being aged 30 to 44 years (OR, 0.72); and being from the Midwest (OR, 0.62) or West (OR, 0.85) was associated with lower naloxone prescription.

There was an increased likelihood of receiving naloxone associated with opioid use disorder treatment; such as use of medication-assisted therapy (OR, 1.68); visiting a detoxification facility (OR, 1.51), or receiving other substance use disorder treatment (OR, 1.16).

“Overall, 98.5% of high-risk patients did not received naloxone, despite many interactions; with the health care system, including 88,618 hospitalizations; 229,680 emergency department visits, 298,058 internal medicine visits, and 568,448 family practice visits,” the authors write.