Naloxone, a fast-acting medication used to block the effects of opioids, can be successfully coprescribed to patients receiving opioid analgesics for chronic pain in primary care. Naloxone coprescribing was associated with reduced opioid-related emergency room visits, suggesting that adopting this practice could reduce opioid-related adverse events. The findings are published in Annals of Internal Medicine.
Unintentional opioid overdose is a leading cause of injury-related death in the United States. Many interventions to curb opioid-related morbidity and mortality have not proven effective, but targeted distribution of naloxone to those likely to witness or experience an opioid overdose, mainly illicit drug users, has been associated with substantial reductions in opioid overdose mortality in communities where this practice is implemented. In San Francisco, implementation and expansion of a targeted naloxone distribution program was associated with a temporary decline in heroin-related deaths. However, the number of deaths attributed to opioid analgesics taken for chronic pain continued to climb. Limited research suggests that prescribing naloxone to these patients when they receive their opioid prescriptions could decrease overdose.
Researchers developed a standardized naloxone coprescribing program (Naloxone for Opioid Safety Evaluation, or NOSE) at primary care clinics in a safety net system in San Francisco to assess the feasibility of introducing and scaling up naloxone coprescribing. They also conducted analyses to assess the association of naloxone coprescribing with emergency room utilization and prescribed opioid dose. They found that more than one third of patients were prescribed naloxone, with the most going to patients who had previous opioid-related emergency room visits and those on higher opioid doses. Compared to patients not prescribed naloxone, patients prescribed naloxone had substantially fewer opioid-related emergency room visits even when there was no net change in opioid dose.
Article: Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain, Phillip O. Coffin, MD, MIA; Emily Behar, MA; Christopher Rowe, MPH; Glenn-Milo Santos, PhD, MPH; Diana Coffa, MD; Matthew Bald, MD; and Eric Vittinghoff, PhD, Annals of Internal Medicine, doi:10.7326/M15-2771, published online 28 June 2016.
Editorial: Mainstreaming Naloxone Through Coprescription to Patients Receiving Long-Term Opioid Therapy for Chronic Pain, Alexander Y. Walley, MD, MSc; and Traci C. Green, PhD, MSc, Annals of Internal Medicine, doi:10.7326/M16-1348, published online 28 June 2016.