Most patients at high risk of opiate overdose do not receive naloxone Rx

Patients at high risk of opioid overdose rarely receive prescriptions for naloxone, despite many interactions with the health care system, according to a study published online May 3 in JAMA Network Open.

Sarah Follman, from the University of Chicago, and colleagues used data from Truven Health MarketScan (Oct. 1, 2015, through Dec. 31, 2016) to identify commercially insured patients (≥15 years) with claims related to opioid use, misuse, dependence, and overdose.

The researchers found that among the 138,108 high-risk individuals (52.4 percent men), 1.5 percent were prescribed naloxone. There was a greater likelihood of receiving naloxone among those patients with prior diagnoses of both opioid misuse or dependence and overdose (odds ratio [OR], 2.32) versus patients with a prior diagnosis of opioid misuse or dependence without overdose. A prior diagnosis of opioid overdose alone was associated with a decreased likelihood of receiving naloxone (OR, 0.73) versus a prior diagnosis of opioid misuse or dependence without overdose. Being aged 30 to 44 years (OR, 0.72) and being from the Midwest (OR, 0.62) or West (OR, 0.85) was associated with lower naloxone prescription. There was an increased likelihood of receiving naloxone associated with opioid use disorder treatment, such as use of medication-assisted therapy (OR, 1.68), visiting a detoxification facility (OR, 1.51), or receiving other substance use disorder treatment (OR, 1.16).

"Overall, 98.5 percent of high-risk patients did not received naloxone, despite many interactions with the health care system, including 88,618 hospitalizations, 229,680 emergency department visits, 298,058 internal medicine visits, and 568,448 family practice visits," the authors write.