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For every 69 high-dose opioid prescriptions, U.S. pharmacies dispensed only one overdose-reversal drug

By Andrew Joseph, STAT, on 8/6/2019 

Prescriptions for naloxone have surged in recent years, as communities struggling with opioid addiction have embraced the overdose-reversing medication. But a new federal report indicates uptake of the antidote is still lagging in much of the country.

While the number of naloxone prescriptions doubled from 2017 to 2018, there was still only one dispensed for every 69 high-dose opioid prescriptions, according to the report from the Centers for Disease Control and Prevention, which was based on retail pharmacy data.

“We may never get to 1-to-1 … but we think that ratio of 1-to-70 is too low,” Dr. Anne Schuchat, the principal deputy director of the CDC, said in an interview.

The CDC report, which analyzed naloxone prescriptions from 2012 to 2018, also uncovered drastic geographic disparities, with some counties dispensing the medication at 25 times the rate of other counties. Dispensing rates were often lowest in rural counties, a finding that Schuchat called “disappointing.”

“In rural areas, it may take a long time for an ambulance to get there,” she said.

There has been halting progress in the effort to slow overdose deaths; health officials say naloxone has been a highly effective tool. But tens of thousands are still dying each year from opioid-related overdoses — including 47,600 people in the U.S. in 2017 — and health authorities stress that a lifesaving medication can only prevent deaths if people have it on hand.

“Thousands of Americans are alive today thanks to the use of naloxone … but today’s CDC report is a reminder that there is much more all of us need to do to save lives,” Health and Human Services Secretary Alex Azar said in a statement.

A number of federal policies and initiatives have been designed to expand the availability of the medication.

In 2016, for instance, the CDC recommended that doctors offer naloxone to chronic pain patients when they prescribe opioids at high doses, which come with higher risks of overdose. But almost 9 million more naloxone doses would had to have been doled out for them to match the number of patients on high-dose opioids, the new report found. (It’s possible that some of these patients already had naloxone on hand, so didn’t need a new supply.)

Public health authorities in states and local governments have also been working to expand naloxone access, issuing standings orders that serve as blanket prescriptions for entire communities — so people don’t need individual prescriptions — and distributing it through syringe exchange sites. Such initiatives are seen as crucial steps in deploying naloxone widely, especially among people who don’t have prescriptions for opioid painkillers but instead use illicit opioids like heroin or other drugs like methamphetamine that might be mixed with opioids.

Some of the report’s other findings:

  • Overall, naloxone prescriptions given out at retail pharmacies grew from 1,282 in 2012 to 556,847 in 2018, the CDC found. Rates were highest in small cities and towns and in the South, and lowest in rural counties and in the Midwest.
  • The report didn’t address the list price of different formulations of naloxone — which some advocates and lawmakers have said make it too expensive for some people — but it did examine other aspects of affordability. The authors found, for example, that while almost three-fourths of Medicare prescriptions for naloxone carried a copay, 42% of commercial plans had one. Overall, 42.3% of prescriptions did not come with an out-of-pocket cost.
  • Psychiatrists, addiction specialists, and pediatricians offered naloxone at the highest rates (12.9, 12.2, and 10.4 naloxone prescriptions per 100 high-dose opioid prescriptions, respectively), whereas surgeons (0.2), pain specialists (1.3), physician assistants (1.3), and primary care doctors (1.3) had the lowest rates.
  • Counties with higher rates of overdose deaths tended to have higher rates of naloxone dispensing, suggesting that awareness of the problem of overdoses could drive more uptake of the reversal drug.

Schuchat said that some naloxone-supporting initiatives were still so new it was hard to assess their effectiveness, but the report indicated that aggressive policies could have an impact. Arizona and Virginia, for example, have enacted requirements for co-prescribing naloxone along with high-dose opioids, and counties in those states tended to have higher naloxone dispensing rates than other places.