Vital Signs: Pharmacy-Based Naloxone Dispensing — United States, 2012–2018

Abstract

Background: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends considering prescribing naloxone when factors that increase risk for overdose are present (e.g., history of overdose or substance use disorder, opioid dosages ≥50 morphine milligram equivalents per day [high-dose], and concurrent use of benzodiazepines). In light of the high numbers of drug overdose deaths involving opioids, 36% of which in 2017 involved prescription opioids, improving access to naloxone is a public health priority. CDC examined trends and characteristics of naloxone dispensing from retail pharmacies at the national and county levels in the United States. Methods: CDC analyzed 2012-2018 retail pharmacy data from IQVIA, a health care, data science, and technology company, to assess U.S. naloxone dispensing by U.S. Census region, urban/rural status, prescriber specialty, and recipient characteristics, including age group, sex, out-of-pocket costs, and method of payment. Factors associated with naloxone dispensing at the county level also were examined. Results: The number of naloxone prescriptions dispensed from retail pharmacies increased substantially from 2012 to 2018, including a 106% increase from 2017 to 2018 alone. Nationally, in 2018, one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. Substantial regional variation in naloxone dispensing was found, including a twenty-fivefold variation across counties, with lowest rates in the most rural counties. A wide variation was also noted by prescriber specialty. Compared with naloxone prescriptions paid for with Medicaid and commercial insurance, a larger percentage of prescriptions paid for with Medicare required out-of-pocket costs. Conclusion: Despite substantial increases in naloxone dispensing, the rate of naloxone prescriptions dispensed per highdose opioid prescription remains low, and overall naloxone dispensing varies substantially across the country. Naloxone distribution is an important component of the public health response to the opioid overdose epidemic. Health care providers can prescribe or dispense naloxone when overdose risk factors are present and counsel patients on how to use it. Efforts to improve naloxone access and distribution work most effectively with efforts to improve opioid prescribing, implement other harm-reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships. Characteristic No. of prescriptions (rate)

Epidemiological and geospatial profile of the prescription opioid crisis in Ohio, United States

“…The countermeasures to limit the effects of the opioid epidemic focusing on limiting prescriptions have resulted in declining overdose deaths by prescription opioids mainly in the female population 16 . Finally, females were found to be more likely to obtain a naloxone prescription than males 21 .…”

“…Additionally, we limited our causal trend analysis to data from January 2011 to December 2016. Some reports have indicated a decrease in deaths by opioid overdose in Ohio during the last semester of 2017 and early 2018, thought to be caused by decreased availability of carfentanyl in the illegal market and the wider availability of naloxone in Ohio and nationwide 21,24 . However, data for opioid overdose mortality data for 2018 are still not available, and there are no official reports for deaths in Ohio by drug overdose for 2018 currently available.…”

Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies

“…[5][6][7] Furthermore, state naloxone dispensing rates and opioid overdose death rates are not correlated, which Freeman et al suggested should be addressed by "improving processes to increase dispensing to areas of need." 6 Guy et al 8 also emphasized disparities in naloxone dispensing and found that only 1 naloxone prescription was dispensed for every 69 high-dose opioid prescriptions nationally, with the lowest rates of dispensing in rural counties.…”

Capsule Commentary on Lin et al., “Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults

“…Lin et al's findings echo a recent report from the Centers for Disease Control and Prevention (CDC) which found that despite increases in naloxone dispensing, only one of every 69 high-dose prescriptions was dispensed with a naloxone prescription. 2 A potential barrier identified in the CDC analysis was cost: two-thirds of naloxone prescriptions required out-of-pocket costs. Other barriers discussed by Lin et al include lack of clinician training and comfort with discussing the use of naloxone.…”

“…From 2013 to 2017, drug overdoses increased in most states, 3 and of the 70,237 drug overdoses reported in 2017, two out of three overdoses involved opioids. 2 Although the rise in overdose deaths is largely attributed to illicit synthetic opioids, there remain important opportunities for primary care clinicians to prevent opioidrelated overdoses through naloxone prescriptions.…”