Still not enough naloxone where it’s most needed

Aug. 12, 2019
Despite huge overall increase in prescribing, more needed in rural areas

Despite a huge increase in naloxone prescribing in recent years, reports the Centers for Disease Control and Prevention in the latest Vital Signs study published today that far too little naloxone is being dispensed in many areas of the country that need it the most.

The overdose-reversing drug naloxone saves lives – but only if it’s readily available when an overdose occurs. Moreover, too few doctors are prescribing naloxone to patients receiving high-dose opioids or opioids plus benzodiazepines or to those with a substance use disorder as recommended by CDC’s Guideline for Prescribing Opioids for Chronic Pain.

Nearly 9 million more naloxone prescriptions could have been dispensed in 2018 if every patient with a high-dose opioid prescription were offered naloxone.

In 2017, 47,600 people in the U.S. died as a result of drug overdoses involving opioids. The prescribing and dispensing of naloxone is a critical part of the public health response to the opioid overdose epidemic.

Current efforts have focused on expanding access to naloxone through prescribing and pharmacy-based distribution. Up-to-date information on pharmacy-based naloxone dispensing is needed. To address this gap and to inform future overdose prevention and response efforts, CDC examined trends and characteristics of how naloxone is dispensed from U.S. retail pharmacies at the national and county levels.

While the findings show an increase in naloxone dispensing from 2012 to 2018, study data confirm additional efforts are needed to improve naloxone access at the local level. Wide variations in dispensing in pharmacies exist, despite consistent state laws.

In 2018, rural counties had the lowest dispensing rates. Primary care providers wrote only 1.5 naloxone prescriptions per 100 high-dose opioid prescriptions – a marker for opioid overdose risk – and over half of naloxone prescriptions required a copay.

Key findings:

· The number of naloxone prescriptions dispensed doubled from 2017 to 2018.

· Only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions nationwide.

·  Most (71 percent) Medicare prescriptions for naloxone required a copay, compared to 42 percent  for commercial insurance.

· Rural counties were nearly 3 times more likely to be a low-dispensing county compared to metropolitan counties.

· Naloxone dispensing is 25 times greater in the highest-dispensing counties than the lowest-dispensing counties.