Few at risk for opioid overdose get potentially life-saving naloxone

(Reuters Health) – A tiny percentage of people at high risk for opioid overdose are getting prescriptions for naloxone, a medication that could potentially save their lives, a new study finds.

Researchers determined that a mere 1.5 percent of high-risk patients were prescribed naloxone, which can reverse an overdose, according to the study published in JAMA Network Open.

“We expected to see a low number, but what we found was very surprising,” said study coauthor Dr. Mai Tuyet Pho, an assistant professor in the section of Infectious Diseases and Global Health at the University of Chicago Medical Center. “Naloxone is very, very much underutilized in the healthcare setting. This presents a huge opportunity for healthcare providers to talk to their patients, particularly those at risk for overdose, about naloxone and how to use it.”

To take a closer look at naloxone prescriptions, Pho and her team turned to a national database of private insurance claims, Truven Health MarketScan. They analyzed data collected between October 1, 2015 and December 31, 2016.

Out of nearly 33.5 million individuals in the database, researchers identified 138,108 U.S. patients aged 15 and older with claims related to opioid misuse or dependence, opioid related overdose, or both. Among those patients, just 2,135, or 1.5 percent, received prescriptions for naloxone after a hospitalization, a visit to an emergency room or a visit to a doctor’s office.

Patients were more likely to receive a naloxone prescription if they had a prior diagnosis of opioid misuse or dependence along with an overdose compared to individuals who had those diagnoses without an overdose, the researchers reported. But having a prior diagnosis of an opioid overdose alone was associated with a decreased likelihood of receiving naloxone compared with a prior diagnosis of opioid misuse or dependence without a history of overdose.

In fact, among the 8,895 patients who had a history of opioid overdose, but no formal diagnosis of opioid misuse or dependence, only 74, or 0.8 percent, received naloxone. And keep in mind, Pho said, “there is no greater risk factor for a fatal overdose than a prior overdose.”

Patients were also less likely to receive naloxone if they were between the ages of 30 and 44 and if they lived in the West or Midwest.

Pho suspects that much of the problem can be explained by stigma.

“I think there’s a reluctance to have an open discussion on this subject,” she said. “Substance use disorder has not been normalized yet.”

“This is a call to arms on the healthcare side,” Pho said. “For a long time healthcare providers have let this responsibility fall to the community based organizations. They do a great job, but I think it’s time for prescribers to mobilize.”

Experts not affiliated with the new research said things have improved since the time period analyzed in the new report.

“I think there’s more naloxone out there now,” said Dr. Michael Fingerhood, an associate professor of medicine and public health at Johns Hopkins University and chief of the division of addiction medicine at the Johns Hopkins Bayview Medical Center. “But at the same time, the potential for overdose is getting worse. We haven’t seen the peak of overdoses yet.”

Dr. Michael Lynch agreed that more are getting naloxone prescriptions now. “If the study period was 15 months later the findings would be different and the overall percentage would be higher than 1.5 percent,” said Lynch, a toxicologist and emergency medicine physician and medical director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center. “But I suspect it would still be lower than any of us would want it to be. I think there are still a lot of missed opportunities to get this medication in the hands of the people who need it.”

Many physicians are still uncomfortable prescribing naloxone, Lynch said. “And there is a percentage of physicians who hold onto the false narrative that naloxone will somehow enable or encourage patients to use opioids,” he said.

SOURCE: bit.ly/2VHt2ct JAMA Network Open, online May 3, 2019.