TY - JOUR
KW - Aged
KW - Analgesics, Opioid/adverse effects
KW - Cross-Sectional Studies
KW - Humans
KW - Medicare
KW - Naloxone/therapeutic use
KW - Opioid-Related Disorders/drug therapy/epidemiology
KW - Retrospective Studies
KW - United States/epidemiology
KW - naloxone
KW - Opioids
KW - Overdose prevention
KW - Prescribing
AU - B. D. Stein
AU - R. Smart
AU - C. M. Jones
AU - F. Sheng
AU - D. Powell
AU - M. Sorbero
A1 - 
AB - BACKGROUND: Naloxone co-prescribing to individuals at increased opioid overdose risk is a key component of opioid overdose prevention efforts. OBJECTIVE: Examine naloxone co-prescribing in the general population and assess how co-prescribing varies by individual and community characteristics. DESIGN: Retrospective cross-sectional study. We conducted a multivariable logistic regression of 2017-2018 de-identified pharmacy claims representing 90% of all prescriptions filled at retail pharmacies in 50 states and the District of Columbia. PATIENTS: Individuals with opioid analgesic treatment episodes > 90 days MAIN MEASURES: Outcome was co-prescribed naloxone. Predictor variables included insurance type, primary prescriber specialty, receipt of concomitant benzodiazepines, high-dose opioid episode, county urbanicity, fatal overdose rates, poverty rates, and primary care health professional shortage areas. KEY RESULTS: Naloxone co-prescribing occurred in 2.3% of long-term opioid therapy episodes. Medicaid (aOR 1.87, 95%CI 1.84 to 1.90) and Medicare (aOR 1.48, 95%CI 1.46 to 1.51) episodes had higher odds of naloxone co-prescribing than commercial insurance episodes, while cash pay (aOR 0.77, 95%CI 0.74 to 0.80) and other insurance episodes (aOR 0.81, 95%CI 0.79 to 0.83) had lower odds. Odds of naloxone co-prescribing were higher among high-dose opioid episodes (aOR 3.19, 95%CI 3.15 to 3.23), when concomitant benzodiazepines were prescribed (aOR 1.12, 95%CI 1.10 to 1.14), and in counties with higher fatal overdose rates. CONCLUSION: Co-prescription of naloxone represents a tangible clinical action that can be taken to help prevent opioid overdose deaths. However, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, we found that co-prescribing rates remain low overall. States, insurers, and health systems should consider implementing strategies to facilitate increased co-prescribing of naloxone to at-risk individuals.
AD - RAND Corporation, Pittsburgh, PA, USA. stein@rand.org.; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. stein@rand.org.; RAND Corporation, Santa Monica, CA, USA.; Centers for Disease Control and Prevention, Atlanta, GA, USA.; RAND Corporation, Arlington, VA, USA.; RAND Corporation, Arlington, VA, USA.; RAND Corporation, Pittsburgh, PA, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
CP - 10
DO - 10.1007/s11606-020-06577-5
IS - 10
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Naloxone co-prescribing to individuals at increased opioid overdose risk is a key component of opioid overdose prevention efforts. OBJECTIVE: Examine naloxone co-prescribing in the general population and assess how co-prescribing varies by individual and community characteristics. DESIGN: Retrospective cross-sectional study. We conducted a multivariable logistic regression of 2017-2018 de-identified pharmacy claims representing 90% of all prescriptions filled at retail pharmacies in 50 states and the District of Columbia. PATIENTS: Individuals with opioid analgesic treatment episodes > 90 days MAIN MEASURES: Outcome was co-prescribed naloxone. Predictor variables included insurance type, primary prescriber specialty, receipt of concomitant benzodiazepines, high-dose opioid episode, county urbanicity, fatal overdose rates, poverty rates, and primary care health professional shortage areas. KEY RESULTS: Naloxone co-prescribing occurred in 2.3% of long-term opioid therapy episodes. Medicaid (aOR 1.87, 95%CI 1.84 to 1.90) and Medicare (aOR 1.48, 95%CI 1.46 to 1.51) episodes had higher odds of naloxone co-prescribing than commercial insurance episodes, while cash pay (aOR 0.77, 95%CI 0.74 to 0.80) and other insurance episodes (aOR 0.81, 95%CI 0.79 to 0.83) had lower odds. Odds of naloxone co-prescribing were higher among high-dose opioid episodes (aOR 3.19, 95%CI 3.15 to 3.23), when concomitant benzodiazepines were prescribed (aOR 1.12, 95%CI 1.10 to 1.14), and in counties with higher fatal overdose rates. CONCLUSION: Co-prescription of naloxone represents a tangible clinical action that can be taken to help prevent opioid overdose deaths. However, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, we found that co-prescribing rates remain low overall. States, insurers, and health systems should consider implementing strategies to facilitate increased co-prescribing of naloxone to at-risk individuals.
PB - . This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply
PY - 2021
SN - 1525-1497; 0884-8734; 0884-8734
SP - 2952
EP - 2957
EP - 
T1 - Individual and Community Factors Associated with Naloxone Co-prescribing Among Long-term Opioid Patients: a Retrospective Analysis
T2 - Journal of general internal medicine
TI - Individual and Community Factors Associated with Naloxone Co-prescribing Among Long-term Opioid Patients: a Retrospective Analysis
U1 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
U2 - 33598891
U3 - 10.1007/s11606-020-06577-5
VL - 36
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2021
Y2 - Oct
ER -