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5 Articles in this Series
Florida #1 in Opioid Prescribing
Love and Pain
Myofascial Pain Syndromes
Naloxone Under Prescribed by Pain Physicians
Preventing 'Pharmacomistakes' at End of LIfe

Naloxone Under Prescribed by Pain Physicians

Twenty-five States Have Enacted Naloxone Laws, Allowing First Responders and Family Authorization to Administer Naloxone in Suspected Opioid Overdoses

What is the one thing that clinicians can do to prevent accidental opioid overdose? Prescribe naloxone to patients, or to the family members of patients, who have presented with a potential concern for an opioid overdose. Naloxone has been around for over 40 years, noted Detective Sergeant Lisa McElhaney, Vice President of the National Association of Drug Diversion Investigators (NADDI).

An injection of naloxone, now available in auto-inject packaging (Evzio), can reverse the effects of opioid overdose, saving lives. Despite these facts, not one clinician in the audience noted that they had prescribed the reversal agent. Why? According to Det Sgt. McElhaney, it is a lack of awareness among physicians.

As most pain prescribers are aware, opioid overdose is a major public health problem, accounting for almost 17,000 deaths a year in the United States. As prescription opioids become harder to obtain, manipulate, and abuse, “people who developed a taste for opioids” began turning to the less expensive alternative: heroin.

Heroin use has been on the rise in the United States, with the North East, Ohio, and Pacific North West seeing significant spikes in cases of heroin overdoses, said Det Sgt. McElhaney, who discussed the rising tide of heroin overdoes during a presentation at PAINWeek.

Naloxone laws have been enacted in 25 states across the country. These laws allow protection for first responders—such as police and firefighters—as well as friends, family or clinicians who administer the opioid antagonist in cases of overdose.1

Because drug overdoses often involve a multiple cocktail of agents, Det Sgt. McElhaney noted that naloxone is not effective for overdoses involving benzodiazepines, barbiturates, or stimulants like cocaine or methamphetamine. “However, if opioids are taken in combination with other sedatives or stimulants, naloxone may be helpful,” she added.

How to Talk to Patients

When talking with patients, Eric Ehlenberger, MD, a pain management and addiction specialist in New Orleans, noted that “I emphasize the potential for accidental overdose related to a child or other family member ingesting the patient’s medications when I encourage my patients to fill the naloxone prescription. When that argument fails," he noted, "I point out that accidental pet ingestion is also treatable with naloxone, and it is not unusual for dogs to quickly chomp down on a bottle of spilled pills before they can be stopped. My vet tells me naloxone is effective and safe for dogs and cats."

"Of course, the argument remains for accidental overdose by the patient, but I de-emphasize that because every patient denies that possibility," said Dr. Ehlenberger.

According to the SAMHSA Opioid Overdose Toolkit, health care providers can reduce the toll of opioid overdoses through careful patient assessment when prescribing opioids and diligent monitoring of patients’ responses to therapy. [Editor Note: Federally funded CME courses are available at no charge at: http://www.OpioidPrescribing.com].


1.      The Network for Public Health Law. Legal interventions to reduce overdose mortality: Naloxone access and overdose Good Samaritan laws. https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf. Accessed September 29, 2014.


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