Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States

Sohn, Minji; Talbert, Jeffery; Huang, Zhengyan; Lofwall, Michelle R.; Freeman, Thomas R.

doi:10.1001/jamanetworkopen.2019.6215

Cited by 82 publications

(71 citation statements)

References 20 publications

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“…34 Co-prescribing naloxone policies were evaluated and showed dramatically increased naloxone dispensing after implementation. 35 Studies by Bounthavong et al, 25 Cox et al, 26 The authors demonstrated how giving pharmacists more responsibility over the primary pharmacological management of patients could improve patient outcomes while also providing potential cost savings.…”

Section: Resultsmentioning

confidence: 99%

“…The Department of Health and Human Services and two Food and Drug Administration (FDA) panels have both endorsed co‐prescribing of naloxone for both lower overdose‐risk users of high‐dose, extended‐use of prescription opioids, and higher‐risk patients diagnosed with OUD and/or with a history of nonfatal overdose . Co‐prescribing naloxone policies were evaluated and showed dramatically increased naloxone dispensing after implementation …”

Section: Discussionmentioning

confidence: 99%

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Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Bratberg

Smothers

Collins

et al. 2019

J Am Coll Clin Pharm

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Introduction Nearly 2.5 million Americans have an opioid use disorder (OUD) related to prescription and/or illicit opioids. Pharmacists, as one of the most accessible care providers, are essential in mitigating the mortality and morbidity of the opioid overdose crisis. Pharmacists are involved in numerous care activities related to this crisis and to caring for patients with an OUD. Objective The objective of this paper was to conduct a literature review to highlight several pharmacist‐driven practices that provide a broad range of prevention, harm reduction, treatment, and recovery services to patients affected or potentially affected by the opioid crisis. Methods Articles had to meet the criteria of describing pharmacist‐led practice related to providing care to patients at risk of an opioid overdose, with an OUD, or related to opioid safety. The literature search was conducted in 2018 and utilized numerous sources including: OneSearch (EBSCOhost), PubMed, ScienceDirect, and the Journal of the American Pharmacists Association Opioid Topic Collection. Results Seven articles were chosen for inclusion in this review. These studies report on innovative programs and practices that describe the role of pharmacists in the opioid crisis. Studies demonstrate the types of involvement pharmacists have in caring for patients throughout the care continuum: actively engaged in upstream interventions aimed at preventing misuse and improve safety; screening and monitoring opioid prescribing and usage; providing access to naloxone; and, assisting in the recovery and rehabilitation process of patients with OUD, including collaboratively managing OUD with evidence‐based pharmacotherapy. Conclusion The studies included in our narrative review demonstrate how innovative programs and practices can expand the role of pharmacists throughout the entire spectrum of interventions applied to the opioid crisis by capitalizing on their existing skill sets and knowledge.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Bratberg

Smothers

Collins

et al. 2019

J Am Coll Clin Pharm

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“…Third‐party prescribing laws allow friends or family members of persons at risk for opioid overdose to receive naloxone prescriptions. Using state naloxone access law effective dates reported by the Prescription Drug Abuse Policy System (PDAPS) website and prior studies, we created two indicator variables to separately classify state‐quarters in which a pharmacy‐based naloxone law or a third‐party prescribing law was fully implemented. The quarter‐year for each naloxone access law implementation is shown in Appendix .…”

Section: Methodsmentioning

confidence: 99%

Association between state Medicaid expansion status and naloxone prescription dispensing

Sohn

Talbert

Delcher

et al. 2020

Health Services Research

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Objective To test whether Medicaid expansion is associated with (a) a greater number of naloxone prescriptions dispensed and (b) a higher proportion of naloxone prescriptions paid by Medicaid. Data Sources/Study Setting We used the IQVIA National Prescription Audit to obtain data on per state per quarter naloxone prescription dispensing for the period 2011‐16. Study Design In this quasi‐experimental design study, the impact of Medicaid expansion on naloxone prescription dispensing was examined using difference‐in‐difference estimation models. State‐level covariates including pharmacy‐based naloxone laws (standing/protocol orders and direct authority to dispense naloxone), third‐party prescribing laws, opioid analgesic prescribing rates, opioid‐involved overdose death rates, and population size were controlled for in the analysis. Principal Findings Medicaid expansion was associated with 38 additional naloxone prescriptions dispensed per state per quarter compared to nonexpansion controls, on average (P = .030). Also, Medicaid expansion resulted in an average increase of 9.86 percent in the share of naloxone prescriptions paid by Medicaid per state per quarter (P < .001). Conclusions Our study found that Medicaid expansion increased naloxone availability. This finding suggests that it will be important to consider naloxone access when making federal‐ and state‐level decisions affecting Medicaid coverage.

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“…Furthermore, we only had data on naloxone prescriptions dispensed in 2016, and naloxone prescription fills have continued to increase due to heightened attention to expanding naloxone access, 8 particularly in states that implemented coprescription laws requiring naloxone prescriptions for opioidreceiving patients at risk of an opioid overdose. 33 Given efforts to increase naloxone prescribing, research examining future patterns and shifting trends will continue to be needed. Finally, we are unable to determine whether a prescription was dispensed via standing order or issued as a third-party prescription, nor does our cross-sectional data allow us to infer causal relationships.…”

Section: Discussionmentioning

confidence: 99%

An Observational Study of Retail Pharmacy Naloxone Prescriptions: Differences Across Provider Specialties and Patient Populations

et al. 2019

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BACKGROUND: Despite exponential growth in pharmacy-dispensed naloxone, little information is available regarding variation in naloxone prescribing pattern across specialty groups, regions, and patient populations. OBJECTIVE: Explore variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics. DESIGN: Cross-sectional analysis of the 2016 national retail pharmacy naloxone prescription claims from the IQVIA Real Longitudinal Prescriptions database. PARTICIPANTS: Naloxone prescribers and individuals filling naloxone prescriptions. MAIN MEASURES: Descriptive statistics assess differences across prescriber specialty groups in number of naloxone prescribers, patient and prescription characteristics, and geographic variation in naloxone dispensation and naloxone market share across prescriber specialty groups or formulation. KEY RESULTS: In 2016, 100,958 naloxone prescriptions written by 14,026 prescribers were filled by 88,735 patients. Primary care physicians accounted for the largest share of naloxone prescribers (45.9%); pain and anesthesia physicians and non-physicians prescribed to significantly greater numbers of patients (means of 10 and 8, respectively). While responsible for a relatively small share of naloxone dispensed (6.1%), psychiatrists and addiction specialists disproportionately served younger individuals, accounting for 49.5% of all prescriptions for individuals aged 35 and younger. Naloxone fill rates differed greatly across geographic regions, with the highest per capita rates in New England and the most concentrated prescribing in the West South Central and South Atlantic regions, where naloxone prescribers had the highest average numbers of patients (9.7 and 7.9, respectively). The South Atlantic and West South Central also had naloxone markets dominated by the Evzio® auto-injector, responsible for 50.3% and 43.8% of all naloxone dispensed in the regions; in contrast, New England's naloxone market was predominantly comprised of generic formulations (48.8%) and Narcan® nasal spray (45.4%). CONCLUSIONS: Our findings reflect a need to better understand barriers to uptake of naloxone prescribing behavior among physicians and other prescribers to ensure individuals have adequate opportunity to receive naloxone from their treating clinicians.

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Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States

Cited by 82 publications

References 20 publications

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Association between state Medicaid expansion status and naloxone prescription dispensing

An Observational Study of Retail Pharmacy Naloxone Prescriptions: Differences Across Provider Specialties and Patient Populations

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