Coprescribing Laws Linked to Increase in Naloxone Prescriptions

By Anne Harding

June 29, 2019

NEW YORK (Reuters Health) - Retail pharmacies in states that mandate naloxone coprescription with opioids for at-risk individuals dispense nearly eight times as much of the overdose antidote as states without coprescribing laws, according to new findings.

"Physicians and other prescribers might question whether individuals meeting the mandated risk criteria who received a naloxone prescription would actually get the naloxone prescription filled," said Dr. Patricia Freeman, who directs the Center for the Advancement of Pharmacy Practice at the University of Kentucky in Lexington.

"The large increase in naloxone dispensing observed in our study following implementation of the laws in Virginia and Vermont would suggest that the answer is yes - many of them are getting filled so it is worth their time to prescribe!" she told Reuters Health in an email.

States have employed a number of strategies for increasing access to the opioid-overdose antidote naloxone, Dr. Freeman and her team note in JAMA Network Open, online June 21. Most states allow pharmacists to dispense naloxone without a prescription, they add, but this approach has not increased dispensing overall.

The authors compared monthly rates of naloxone prescribing in Virginia, Vermont, the 10 states with the highest rates of OOD in 2016, and the remaining 39 states. During the study period, several states passed laws to increase naloxone access, including allowing the drug to be dispensed without a prescription, for example through a standing order, or allowing naloxone to be prescribed to friends, family and other caregivers of people at risk of OOD.

After Virginia mandated coprescribing, naloxone dispensing increased to 88 per 100,000, while the rate in Vermont in the first month the requirement became law was 111 per 100,000.

In the top 10 OOD states, the average rate was 16 per 100,000, while it was six per 100,000 for the remaining states. (California, Arizona and Rhode Island enacted coprescribing laws in 2018.)

The number of naloxone prescriptions filled was significantly associated with laws requiring coprescription (incidence rate ratio, 7.75). After the mandates took effect, an additional 214 naloxone prescriptions were dispensed per month.

Other factors significantly associated with naloxone dispensing included naloxone access laws (IRR, 1.37), OOD death rates (IRR, 1.06), percentage of naloxone prescriptions covered by third-party payers (IRR, 1.009) and time (IRR, 1.08).

Naloxone dispensing increased by a mean 37% in states that passed third-party prescribing or standing order laws.

"Particular caution is required when interpreting the IRR of the OOD deaths," the authors note. "The data on naloxone dispensing and OOD deaths are not temporal, and they do not suggest a sequence of those events."

"The next step in our research is to look at how these varied interventions (standing orders, pharmacist-based provision, coprescription, etc.) designed to increase access to naloxone impact opioid-overdose deaths," Dr. Freeman said. "Recent work by Abouk and colleagues ( documented that pharmacist-based access laws decrease risk for opioid overdose death. We are interested in understanding if coprescription laws have same or greater impact."

She added: "Prescribing and dispensing naloxone and teaching patients and their loved ones who would be potentially in the position to witness and administer naloxone should this adverse event of overdose occur is one huge step towards minimizing risk and starting larger conversations perhaps about one's health and wellbeing."


JAMA Netw Open 2019.