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A Review of Naloxone Coprescription Mandates in Two States

July 16, 2019
Virginia and Vermont had higher dispensed naloxone prescriptions in the first month of implementation.

A PPM Brief

States have begun to implement new policies regarding opioid prescribing, such as the increase in availability, and the coprescription of, naloxone. Two states, Virginia (April 2017) and Vermont (July 2017), have mandated that physicians co-prescribe naloxone for patients that they consider to be potentially at-risk with opioid use. Researchers from the Institute for Pharmaceutical Outcomes and Policy at the College of Pharmacy at the University of Kentucky, Lexington, assessed the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies per state.

The population-based, state-level observational cohort study used longitudinal data analysis from January 2011 through December 2017. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in a national prescription audit, which represents 90% of all retail pharmacies in the US.

Virginia and Vermont had higher dispensed naloxone prescriptions in the first month of implementation. (Source: 123RF)

In a descriptive, unadjusted analysis, the rate of naloxone dispensing per 10,000 increased significantly on the implementation of legal requirements for naloxone coprescription. Researchers found that:

  • An estimated 88 naloxone prescriptions per 100,000 were dispensed in Virginia and 111 prescriptions per 100,000 were dispensed in Vermont during the first full month the legal requirement was effective (ie, April 2017 for Virginia and July 2017 for Vermont).
  • By comparison, in July 2017, 16 naloxone prescriptions per 100,000 were dispensed in the top 10 states with the highest opioid overdose death rates (West Virginia, New Hampshire, Ohio, Washington, DC, Massachusetts, Maryland, Rhode Island, Maine, Connecticut, and Kentucky) and 6 prescriptions per 100,000 were dispensed in the 39 remaining states without mandated naloxone prescribing.
  • The number of naloxone prescriptions dispensed was found to be associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22 - 49.35). Implementation was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates.
  • Among covariates, naloxone access laws (IRR, 1.37; 1.05 - 1.78), opioid overdose death rates (IRR, 1.06; 95% CI, 1.04 - 1.08), percentage of naloxone prescriptions paid by third-party payors (IRR 1.009; 1.008 - 1.010), and time (IRR, 1.06; 95% CI, 1.05 - 1.07) were significantly associated with naloxone prescription dispensing.

Researchers wrote that legally mandated naloxone prescriptions for those at risk for opioid overdose and receiving opioid prescriptions may be associated with substantial increases in naloxone dispensing and further reduction in risks associated with them. “Our descriptive trend analysis suggests that the association is likely sequential, as the increase in the number of naloxone prescriptions dispensed was observed immediately on implementation of the legal mandates,” they concluded.

In late 2018, California, Arizona, and Rhode Island enacted similar mandates, and the researchers suggested that further evaluation of the association in these states is now also warranted.

Last updated on: August 16, 2019
Continue Reading:
FDA Recommends Co-Prescribing Naloxone with Opioids
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