Legal regimes surrounding naloxone access: considerations for prescribers

Brodrick, Joy E.; Brodrick, Collin K.; Adinoff, Bryon

doi:10.3109/00952990.2015.1109648

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…In conjunction with these opioid stewardship initiatives, overdose education and naloxone rescue for people using prescription opioids was increasingly considered a necessary component of the response to the opioid epidemic. As a result, all but three U.S. states in 2016 have laws supporting naloxone provision to lay persons (Brodrick, Brodrick, & Adinoff, 2016). In recognizing opioid-related overdose as a major public health concern, the US Department of Health and Human Services highlighted naloxone rescue kit access and emergency overdose response as one of three priority areas to address this crisis in 2015 (“HHS takes strong steps to address opioid-drug related overdose, death and dependence,” March 26, 2015).…”

Section: Introductionmentioning

confidence: 99%

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Fairbairn

Coffin

Walley

2017

International Journal of Drug Policy

250

192

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Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone.

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Section: Introductionmentioning

confidence: 99%

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Fairbairn

Coffin

Walley

2017

International Journal of Drug Policy

250

192

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“…Many states also explicitly authorise prescription of naloxone to a third party (i.e. prescription of naloxone to a family member) [ 46 ]. Instructing patients or their caregivers in when and how to use naloxone is also a good opportunity to discuss the risks of opioid medications.…”

Section: Opioid Stewardshipmentioning

confidence: 99%

Primary care management of Long-Term opioid therapy

et al. 2022

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The United States underwent massive expansion in opioid prescribing from 1990–2010, followed by opioid stewardship initiatives and reduced prescribing. Opioids are no longer considered first-line therapy for most chronic pain conditions and clinicians should first seek alternatives in most circumstances. Patients who have been treated with opioids long-term should be managed differently, sometimes even continued on opioids due to physiologic changes wrought by long-term opioid therapy and documented risks of discontinuation. When providing long-term opioid therapy, clinicians should document opioid stewardship measures, including assessments, consents, medication reconciliation, and offering naloxone, along with the rationale to continue opioid therapy. Clinicians should screen regularly for opioid use disorder and arrange for or directly provide treatment. In particular, buprenorphine can be highly useful for co-morbid pain and opioid use disorder. Addressing other substance use disorders, as well as preventive health related to substance use, should be a priority in patients with opioid use disorder. Patient-centered practices, such as shared decision-making and attending to related facets of a patient’s life that influence health outcomes, should be implemented at all points of care. Key messages Although opioids are no longer considered first-line therapy for most chronic pain, management of patients already taking long-term opioid therapy must be individualised. Documentation of opioid stewardship measures can help to organise opioid prescribing and protect clinicians from regulatory scrutiny. Management of resultant opioid use disorder should include provision of medications, most often buprenorphine, and several additional screening and preventive measures.

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“…Community naloxone programs attempt to educate and equip laypeople to administer naloxone in cases of suspected opioid overdose and most states have passed laws to facilitate the administration of naloxone by laypeople in emergency situations, but these laws vary from state to state [12] [13] [14]. Pharmacists in particular are on the front lines and may have to educate patients about naloxone administration, signs of overdose, as well as provide guidance relating to the local Good Samaritan laws governing the administration of naloxone by laypeople [15].…”

Section: Introductionmentioning

confidence: 99%

The Place of Community Rescue Naloxone in a Public Health Crisis of Opioid Overdose

Pergolizzi¹,

LeQuang²,

Taylor³

et al. 2019

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The recent large increase in deaths involving opioids (whether prescription or illicit, pure or adulterated, alone or in combination with other drugs) is the manifestation of a complex, and multifaceted problem consisting of psychological, psychosocial, medical, legal, regulatory, economic, cultural, and political components, among others. Because the problem involves issues related to both supply and demand, the solution is not obvious, simple, or quick. There is no easy fix. Preventing and treating opioid misuse and abuse requires a comprehensive, time-intensive, and expensive intervention supported by public policy and support through coordinated medical, regulatory, legal, and financial guidelines and practice. But until the long-term problems can be fixed, the immediate crisis of overdose deaths can be ameliorated by making available an opioid receptor antagonist to reverse the respiratory depression that is the cause of death to those who are in the best position to administer it in time (professionals, untrained bystanders, and even fellow drug abusers). The statistics overwhelmingly demonstrate that this is a life-saving medical intervention. Yet, there is still uncertainty about this intervention, and even some opposition to it. We describe the scientific basis for the approach and the issues surrounding its use to treat accidental or intentional overdose by pain patients, recreational opioid users, and addicts. We also describe the calls to limit the number of times it should be available to a user and the limitations of its effectiveness-mainly that it only addresses the acute death crisis, not the underlying problems that led to it.

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Legal regimes surrounding naloxone access: considerations for prescribers

Cited by 15 publications

References 18 publications

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Primary care management of Long-Term opioid therapy

The Place of Community Rescue Naloxone in a Public Health Crisis of Opioid Overdose

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