Dr. Nora Volkow, director of the National Institute on Drug Abuse, holds up a nasal spray version of naloxone during a congressional hearing in 2017 in Washington, D.C.(DREW ANGERER/GETTY IMAGES)
Clinicians have not prescribed naloxone, an opioid overdose-reversing drug, enough to meet demand among those who may have needed it most, a new study suggests.
Researchers from the University of Chicago Medicine used a database of private insurance claims to analyze 138,108 cases of patients who showed a high risk of opioid overdose between October 2015 and December 2016 and whether naloxone prescriptions were given to them. Patients included those with claims related to opioid misuse or dependence, an opioid-related overdose or both.
Nearly all – 98.5% – of these high-risk patients did not receive naloxone. Patients who had both an opioid misuse or dependence diagnosis and who had previously overdosed had the highest percentage of those who received the overdose-reversing medication, at 4.6%. Among those who had overdosed before but did not have a misuse or dependence diagnosis, only 0.8% received naloxone.
On average, 130 Americans die each day from an opioid overdose, according to the Centers for Disease Control and Prevention. In the study, patients between the ages of 30 and 44 were less likely than their older counterparts to receive naloxone, and those who had sought treatment for substance misuse had a higher likelihood of getting a naloxone prescription than those who had not.
People from the Midwest or West also had a lower likelihood of being prescribed naloxone compared with those in the Northeast and the South, according to the report.
The patients studied "had opportunities to receive naloxone based on numerous interactions with the health care system," the analysis notes, with 88,618 hospitalizations, nearly 230,000 emergency department visits, 298,058 interactions with internal medicine professionals and 568,448 visits to family practice professionals occurring over the 15-month period.
"Our analysis suggests that health care visits are a missed opportunity to provide naloxone," the study says.
Notably, only injectable forms of naloxone had been approved by the U.S. Food and Drug Administration prior to November 2015, when the FDA approved Narcan, a nasal-spray version of the overdose-reversing drug.
The time frame analyzed in the study also predates a December decision by a Food and Drug Administration advisory panel in favor of recommending that naloxone be dispensed along with prescription opioids – a move the agency appears to be exploring and one the Department of Health and Human Services also has urged clinicians to consider for those at risk of overdose. And in April 2018, the U.S. surgeon general issued an advisory calling for the prescription of naloxone to those at high risk of an opioid overdose, as well as to their friends and family members.
The study's authors additionally note that their analysis does not include people who are typically lower-income and either uninsured or covered by Medicaid or certain Medicare plans, nor does it account for naloxone distribution programs or out-of-pocket payments.
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Still, stigma attached to substance use and mental health disorders may have resulted in a lower prevalence of opioid misuse and overdose documented within the claims data studied, the authors say, as well as an overestimation of naloxone prescribing practices.
The study's results point to the need for increased education for clinicians on screening and treatment for substance use disorders, as well as policies to guide naloxone prescribing.
"Future policy interventions could include increasing funding in geographic regions that prescribe naloxone less frequently than other areas and incentivizing clinical programs and services that reach younger patient populations," the study says. "Promoting naloxone prescribing by leveraging ongoing health care interactions with high-risk patients represents an underused and potentially effective strategy to reduce opioid overdose fatality."
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