HHS Advises Coprescribing Naloxone and Opioids

Megan Brooks

December 19, 2018

The opioid overdose reversal drug naloxone (multiple brands) should be prescribed to all patients at risk for opioid complications, including overdose, according to new guidance released today by the US Department of Health and Human Services (HHS).

"Given the scope of the opioid crisis, it’s critically important that healthcare providers and patients discuss the risks of opioids and how naloxone should be used in the event of an overdose," Adm. Brett P. Giroir, MD, HHS assistant secretary for health and senior advisor for opioid policy, said in a news release.

"We have begun to see some encouraging signs in our response to the opioid crisis, but we know that more work is required to fully reverse the decades-long epidemic. Co-prescribing naloxone when a patient is considered to be at high risk of an overdose, is an essential element of our national effort to reduce overdose deaths and should be practiced widely," Giroir said.

To reduce the risk for overdose deaths, the new guidance recommends that clinicians "strongly" consider prescribing or coprescribing naloxone to the following individuals:

Patients prescribed opioids who:

  • Are receiving opioids at a dosage of 50 morphine milligram equivalents per day or greater

  • Have been prescribed benzodiazepines (regardless of opioid dose); have a nonopioid substance use disorder, report excessive alcohol use, or have a mental health disorder (regardless of opioid dose)

The guidance defines individuals at high risk of experiencing or responding to an opioid overdose as those:

  • Using heroin or illicit synthetic opioids or misusing prescription opioids

  • Using other illicit drugs such as stimulants, including methamphetamine and cocaine, which could potentially be contaminated with illicit synthetic opioids like fentanyl

  • With a history of opioid misuse who were recently released from incarceration or other controlled settings where tolerance to opioids has been lost

The guidance also advises clinicians to educate patients and those who are likely to respond to an overdose, including family members and friends, on when and how to use naloxone in its variety of forms.

"Promoting the targeted availability and distribution of overdose-reversing drugs is one of the five pillars of HHS’s comprehensive, science-based strategy for the opioid epidemic," HHS Secretary Alex Azar said in the release.

"This new guidance reflects our commitment to ensuring those who need overdose-reversing drugs have them and provides practical steps that clinicians, patients, and the public can take to reduce the risk of an overdose," Azar said.

In April 2017, HHS put forth its 5-Point Strategy to Combat the Opioids Crisis. Those efforts include better addiction prevention, treatment, and recovery services; better data; better pain management; better targeting of overdose reversing drugs; and better research.

In April 2018, US Surgeon General Jerome M. Adams, MD, issued an advisory encouraging more individuals, including family, friends, and those who are personally at risk for an opioid overdose, to carry naloxone.

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