Coprescribing mandates seem to increase naloxone dispensing

Several states, including Virginia and Vermont, have laws mandating that clinicians coprescribe naloxone with opioids to high-risk patients. A new study published in JAMA Network Open suggests that these legal mandates are associated with substantial increases in naloxone dispensing.

The state-level cohort study used data from retail pharmacies in all 50 states and the District of Columbia. Researchers found that naloxone coprescription mandates were associated with a 7.75-fold increase in the rate of naloxone dispensing compared to states without mandates. 

"Increasing access to naloxone to those with elevated risk for opioid overdose is an important public health initiative," Patricia Freeman, director of the Center for the Advancement of Pharmacy Practice at the University of Kentucky and corresponding author of the study, said in a statement. "Our study findings demonstrate that naloxone coprescription laws dramatically increase access to naloxone in those states that adopt the policy. As states continue to search for ways to lower opioid-related overdose deaths, enacting similar laws or regulations has the potential to save lives."

The study found that about 88 naloxone prescriptions per 100,000 patients were dispensed in Virginia, and 111 prescriptions per 100,000 patients were dispensed in Vermont during the first full month the legal requirement was effective. In contrast, roughly 16 naloxone prescriptions per 100,000 patients were dispensed in 10 states without mandates and with the highest opioid overdose death rates. Six prescriptions per 100,000 patients were dispensed in the remaining 39 states. 

Arizona, Florida, and Rhode Island also have mandates requiring clinicians to coprescribe naloxone with opioids.

Freeman said the passage of Kentucky Senate Bill 192 in 2015, which gave Kentucky pharmacists the authority to initiate the dispensing of naloxone under a physician-approved protocol, have increased naloxone dispensing significantly in the state.

Earlier this year, the Department of Health and Human Services announced a recommendation for clinicians to coprescribe naloxone to high-risk patients. This includes, but is not limited to, patients who are on relatively high doses of opioids or take other medications along with opioids, as well as patients with opioid use disorder.

The HHS recommendation comes on the heels of an FDA advisory panel’s vote late last year in favor of changing the label for opioids that should be coprescribed with naloxone.