Naloxone Prescriptions Among Commercially Insured Individuals at High Risk of Opioid Overdose

Follman, Sarah; Arora, Vineet M.; Lyttle, C. Richard; Moore, P. Quincy; Pho, Mai T.

doi:10.1001/jamanetworkopen.2019.3209

Cited by 53 publications

(53 citation statements)

References 25 publications

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“… 11 Although naloxone access laws were estimated to increase naloxone dispensing, 36 a recent study found that only 2135 of 138 108 high-risk patients (1.5%) in the US were prescribed naloxone in 2016. 37 This finding suggests that policies designed to dramatically improve treatment for overdose are needed.…”

Section: Discussionmentioning

confidence: 99%

Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018

et al. 2021

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IMPORTANCE In response to the increase in opioid overdose deaths in the United States, many states recently have implemented supply-controlling and harm-reduction policy measures. To date, an updated policy evaluation that considers the full policy landscape has not been conducted. OBJECTIVE To evaluate 6 US state-level drug policies to ascertain whether they are associated with a reduction in indicators of prescription opioid abuse, the prevalence of opioid use disorder and overdose, the prescription of medication-assisted treatment (MAT), and drug overdose deaths. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used drug overdose mortality data from 50 states obtained from the National Vital Statistics System and claims data from 23 million commercially insured patients in the US between 2007 and 2018. Difference-indifferences analysis using panel matching was conducted to evaluate the prevalence of indicators of prescription opioid abuse, opioid use disorder and overdose diagnosis, the prescription of MAT, and drug overdose deaths before and after implementation of 6 state-level policies targeting the opioid epidemic. A random-effects meta-analysis model was used to summarize associations over time for each policy and outcome pair. The data analysis was conducted July 12, 2020. EXPOSURES State-level drug policy changes to address the increase of opioid-related overdose deaths included prescription drug monitoring program (PDMP) access, mandatory PDMPs, pain clinic laws, prescription limit laws, naloxone access laws, and Good Samaritan laws. MAIN OUTCOMES AND MEASURES The outcomes of interests were quarterly state-level mortality from drug overdoses, known indicators for prescription opioid abuse and doctor shopping, MAT, and prevalence of drug overdose and opioid use disorder. RESULTS This cross-sectional study of drug overdose mortality data and insurance claims data from 23 million commercially insured patients (12 582 378 female patients [55.1%]; mean [SD] age, 45.9 [19.9] years) in the US between 2007 and 2018 found that mandatory PDMPs were associated with decreases in the proportion of patients taking opioids (−0.729%; 95% CI, −1.011% to −0.447%), with overlapping opioid claims (−0.027%; 95% CI, −0.038% to −0.017%), with daily morphine milligram equivalent greater than 90 (−0.095%; 95% CI, −0.150% to −0.041%), and who engaged in drug seeking (−0.002%; 95% CI, −0.003% to −0.001%). The proportion of patients receiving MAT increased after the enactment of mandatory PDMPs (0.015%; 95% CI, 0.002% to 0.028%), pain clinic laws (0.013%, 95% CI, 0.005%-0.021%), and prescription limit laws (0.034%, 95% CI, 0.020% to 0.049%). Mandatory PDMPs were associated with a decrease in the number of overdose deaths due to natural opioids (−518.5 [95% CI, −728.5 to −308.5] per 300 million people) and methadone (−122.7 [95% CI, −207.5 to −37.8] per 300 million people). Prescription drug monitoring program access policies showed similar results, although these policies were also associated with increases in overdos...

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Section: Discussionmentioning

confidence: 99%

Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018

et al. 2021

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“…Interprofessional collaborations and education in interventions about opioid risk counseling and naloxone prescribing have proven to be effective and should be implemented and devised for enhanced patient safety. [67][68][69][70] National associations would then have an added opportunity to facilitate adoption of best practices and competencies for pharmacists dispensing naloxone. With this information, state associations can create education programs that align with state-specific regulations regarding standing orders and naloxone dispensing.…”

Section: Discussionmentioning

confidence: 99%

Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review

Thakur¹,

Frey²,

Chewning³

2020

Journal of the American Pharmacists Association

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“…This study suggests that PDMP mandates may prevent adolescents from beginning down the path of opioid addiction and IDU, which is important to consider alongside evidence that PDMPs could prompt people who are already using opioids to transition to illicit substances [27]. Enactment of PDMP mandates could complement other evidence-based interventions, such as expanded addiction treatment [44,45], naloxone distribution [46,47], safe prescribing interventions [48], and harm reduction services [49].…”

Section: Plos Medicinementioning

confidence: 95%

State-level prescription drug monitoring program mandates and adolescent injection drug use in the United States, 1995–2017: A difference-in-differences analysis

2020

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Background Prescription opioid misuse is an ongoing crisis and a risk factor for injection drug use (IDU). Few studies have evaluated strategies for preventing opioid or IDU initiation among adolescents. We evaluated changes in the proportion of adolescents reporting IDU before and after prescription drug monitoring program (PDMP) mandates were implemented in 18 states compared to 29 states without such mandates. Methods and findings This difference-indifferences analysis used biannual Youth Risk Behavioral Surveillance System (YRBSS) data representative of adolescents 17 to 18 years old across 47 states from 1995 to 2017. We compared changes in adolescent IDU in 18 states with and 29 states without PDMP mandates. Among 331,025 adolescents, 51.7% identified as male, 62.1% as non-Hispanic white, 17.4% as non-Hispanic black, and 14.6% as Hispanic. Overall, 3.5% reported IDU during the 2 years prior to PDMP mandates. In the final multivariable difference-indifferences model, we included individual age, sex, and race/ethnicity, as well as state and year as covariates from the YRBSS. We also included state-and year-specific poverty rates based on US Census Bureau data. Additionally, we controlled for state implementation of (non-mandated) PDMPs before states subsequently implemented mandates and pill mill laws. We conducted several sensitivity analyses, including repeating our main analysis using a logistic, rather than linear, model, and with a lead indicator on PDMP mandate implementation, a lag indicator, and alternative policy implementation dates. PDMP mandates were associated with a 1.5 percentage point reduction (95% CI −2.3 to −0.6 percentage points; p = 0.001) in adolescent IDU, on average over the years following mandate implementation, a relative reduction of 42.9% (95% CI −65.7% to −17.1%). The association PLOS MEDICINE

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Naloxone Prescriptions Among Commercially Insured Individuals at High Risk of Opioid Overdose

Cited by 53 publications

References 25 publications

Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018

Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018

Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review

State-level prescription drug monitoring program mandates and adolescent injection drug use in the United States, 1995–2017: A difference-in-differences analysis

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