Naloxone should be coprescribed to high-risk patients, say federal agencies

The U.S. Surgeon General wants naloxone to be in the hands of more people and has openly urged physicians to prescribe it. Now, federal agencies are following this lead with their own calls to action. The Department of Health and Human Services (HHS) recently 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.

But how much is known about the benefits of coprescribing naloxone, and what should pharmacists keep in mind?

Several states, including Arizona, Florida, Rhode Island, Virginia, and Vermont, have laws mandating that clinicians coprescribe naloxone with opioids.

At the FDA advisory panel meeting last year, Jeffrey Bratberg, PharmD, clinical professor at the University of Rhode Island College of Pharmacy in Kingston, presented data based on Rhode Island’s recent mandate to coprescribe naloxone, which followed other measures the state already had in place to make naloxone more widely available.

“We are kind of the perfect storm here in Rhode Island to increase access to naloxone given everything else we have done leading up to coprescribing,” said Bratberg.

There is a standing order for naloxone in almost every pharmacy in the state as well as mandated insurance coverage for naloxone. “But it was really this [coprescribing] policy that has pushed up the amount of naloxone going out,” Bratberg said.

Since the coprescribing mandate in Rhode Island went into effect last summer, more naloxone has been dispensed from pharmacies in 5 months than in the past 2 years, according to Bratberg.

“We’d all love to follow the Surgeon General’s recommendation to carry this, but not everyone can if they have financial barriers [or] insurance coverage barriers, or they go to their pharmacy and it’s just not stocked due to stigma,” he said.

The main concern about making coprescribing a federal mandate—if that were a possibility—would be the potential increase to annual health care costs, a concern that was also brought up during the FDA meeting. In addition to coprescribing, the FDA meeting focused on other ways to make naloxone more widely available, such as creating a low-cost OTC naloxone product.

FDA said earlier this year that it would help make development of OTC naloxone easier for drug manufacturers. From an accessibility standpoint this sounds hopeful, but questions remain about the costs to patients if an OTC naloxone product is highly priced and if insurance coverage is no longer an option.

For the full article, please visit for the March 2019 issue of Pharmacy Today.