Prescriptions for naloxone have surged in recent years, as communities struggling with opioid addiction have embraced the overdose-reversing medication. But a new federal report indicates uptake of the antidote is still lagging in much of the country.
While the number of naloxone prescriptions doubled from 2017 to 2018, there was still only one dispensed for every 69 high-dose opioid prescriptions, according to the report from the Centers for Disease Control and Prevention, which was based on retail pharmacy data.
“We may never get to 1-to-1 … but we think that ratio of 1-to-70 is too low,” Dr. Anne Schuchat, the principal deputy director of the CDC, said in an interview.
The CDC report, which analyzed naloxone prescriptions from 2012 to 2018, also uncovered drastic geographic disparities, with some counties dispensing the medication at 25 times the rate of other counties. Dispensing rates were often lowest in rural counties, a finding that Schuchat called “disappointing.”
“In rural areas, it may take a long time for an ambulance to get there,” she said.
There has been halting progress in the effort to slow overdose deaths; health officials say naloxone has been a highly effective tool. But tens of thousands are still dying each year from opioid-related overdoses — including 47,600 people in the U.S. in 2017 — and health authorities stress that a lifesaving medication can only prevent deaths if people have it on hand.
“Thousands of Americans are alive today thanks to the use of naloxone … but today’s CDC report is a reminder that there is much more all of us need to do to save lives,” Health and Human Services Secretary Alex Azar said in a statement.
A number of federal policies and initiatives have been designed to expand the availability of the medication.
In 2016, for instance, the CDC recommended that doctors offer naloxone to chronic pain patients when they prescribe opioids at high doses, which come with higher risks of overdose. But almost 9 million more naloxone doses would had to have been doled out for them to match the number of patients on high-dose opioids, the new report found. (It’s possible that some of these patients already had naloxone on hand, so didn’t need a new supply.)
Public health authorities in states and local governments have also been working to expand naloxone access, issuing standings orders that serve as blanket prescriptions for entire communities — so people don’t need individual prescriptions — and distributing it through syringe exchange sites. Such initiatives are seen as crucial steps in deploying naloxone widely, especially among people who don’t have prescriptions for opioid painkillers but instead use illicit opioids like heroin or other drugs like methamphetamine that might be mixed with opioids.
Some of the report’s other findings:
- Overall, naloxone prescriptions given out at retail pharmacies grew from 1,282 in 2012 to 556,847 in 2018, the CDC found. Rates were highest in small cities and towns and in the South, and lowest in rural counties and in the Midwest.
- The report didn’t address the list price of different formulations of naloxone — which some advocates and lawmakers have said make it too expensive for some people — but it did examine other aspects of affordability. The authors found, for example, that while almost three-fourths of Medicare prescriptions for naloxone carried a copay, 42% of commercial plans had one. Overall, 42.3% of prescriptions did not come with an out-of-pocket cost.
- Psychiatrists, addiction specialists, and pediatricians offered naloxone at the highest rates (12.9, 12.2, and 10.4 naloxone prescriptions per 100 high-dose opioid prescriptions, respectively), whereas surgeons (0.2), pain specialists (1.3), physician assistants (1.3), and primary care doctors (1.3) had the lowest rates.
- Counties with higher rates of overdose deaths tended to have higher rates of naloxone dispensing, suggesting that awareness of the problem of overdoses could drive more uptake of the reversal drug.
Schuchat said that some naloxone-supporting initiatives were still so new it was hard to assess their effectiveness, but the report indicated that aggressive policies could have an impact. Arizona and Virginia, for example, have enacted requirements for co-prescribing naloxone along with high-dose opioids, and counties in those states tended to have higher naloxone dispensing rates than other places.
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Could you please provide me with contact names in AZ and VA whom I could contact about how they got their state legislatures to pass requirements to co-prescribe naloxone with high-dose opioid prescriptions?
Thank you.
Joan Lane
I am sorry to hear about the problem of overdoses but the abusers are the one set that are hurting the people that need this medicine to live a productive life keep their jobs take care of their family pay taxes….. I’m not responsible for the drug abuse nor should good doctors that are trying to help the legitimate people that need ot
The title of this article needs a reality check. Chronic pain sufferers are not the same people as opioid abusers, and those two groups can not blatantly be lumped together. Chronic pain patients use proper dosage that supports leading a bearable life. They don’t need naloxone. It is the “druggies” that do, and naloxone should be at-the-ready without prescription for first responders, ER’s, designated personnel in public places, etc. There is rhyme nor reason for this ratio-study approach.
Having worked with cancer and regular chronic pain patients for over 40 years, I have seen pretty much everything. Some of the earlier comments I completely agree with. This entire thing of now trying to further tie up our hands with 3, 7, repeat day follow ups and treatments is absurd, a big time waste for us physicians and patients. And, do tell me the difference between chronic cancer pain vs traumatic pain? A different pair of pliers!! It hurts the SAME!!
Big Pharma and the CDC screwed up 15-20 years ago, when there was “no ceiling” to the amount of opoids we could/should prescribe; then JCAHO and their “5th vital sign”!! All the bureaucrats played Dr.–without a license!! And now they want to legislate and Naloxone their way out, further compromising good, appropriate pain management. That really gets to the root cause of the problem, doesn’t it–appropriate and adequate psycho-social availability and funding!! What every one of these “Doctors” needs is virtual intractable pain for 90-180 days, and have them come to me for pain management (try some NSAIDs and massages, doc!!). Are there “pill mills” out there? Of course! But then work harder on ferreting them out and prosecuting accordingly.
Finally, over 60K people have died of the flu for quite a few years; that does not include the residual chronic damage, loss of wages, etc. The CDC answer: “Oh, we missed the target virus”–AGAIN!! You are missing the target re pain management with all of your “chronic” legislation.
Please define a “high-dose opioid prescription.”
Amazing
Are you talking about 69 patients, or 69 prescriptions? Because there are no refills. Every month is o e or two new medication scripts. That would equal one naloxone (which will sit in a drawer for three years, because taken as directed, there is no overdose, no high, no euphoria…just good old fashioned relief enough to function). One person. One naloxone. 72 prescriptions for long acting and breakthrough medication over three years. WHY WOULD YOU WANT 1:1 ??? Do I need 24 naloxone doses a year???
They are being collected and used as ‘naloxone parties’, so drugs can be used without calling EMS or emergency room, and no treatment counseling is received.
There is no evidence that forcing people who are in a pain management program and under a physicians care, would benefit from an expensive Nalaxone prescription. Smearing and stigmatizing patients with intractable chronic pain was a tactic the pharmaceutical industry came up with the take attention away from their activities.
In a nation of alternate facts, and pharma industry lies and propaganda, there does not have to be a proven benefit. These devices seem to be more useful when the people who are addicted to street drugs have access to them. Thanks to the deceptive and misleading coverage of these topics, and the conflation of pain patients and people addicted to street drugs were are 22 years out and no closer to a fact based response.
US Taxpayers paid for the development of Nalaxone, and a pharma company repackaged it, and now makes an obscene profit from it. The so called opioid epidemic, was a good marketing campaign, designed to mislead us all. Pharma created this problem, and the FDA and CDC failed to respond in a sensible way, because they were compromised by corporate interests.
In order to keep this ruse going the pharma industry wanted pain patients to be confused with drug addicts. They paid a lot of money for research that attempted to prove it. Due to this misinformation campaign, pain patients were stigmatized, blamed, and driven to isolation and suicide, by design. At no time did the CDC consider the unintended consequences of their actions and unscientific response to this issue.
I get monthly opioid Rx’s which I take as prescribed. They help my intractable chronic pain. They do NOT make me feel at all high.
Given that I follow my very qualified pain manager’s orders, I feel no need to buy the expensive overdose Rx which my doctor was legally required to prescribe.
AGAIN, research proves that overdoses are virtually all caused by ILLEGAL drugs — mostly heroin and fentenyl. If legal Rx drugs are involved in an OD, then they are stolen, and/or used in conjunction with alcohol or illegal drugs.
Chronic pain patients who take their drugs as prescribed, and who are not addicts or criminals, do not need the overdose drugs because they/we do not overdose.
We are patients like any other patients, taking the meds we need to survive.
As usual, and to our great detriment, we chronic pain patients are incorrectly lumped into the same group as the addicts and criminals.
When will this end???
I agree. I have had chronic pain since I broke my back. My MD prescribes 4 Oxycodones a day. Some days are so bad that I need to take 5 and try and make up for it by taking 3 the next day. If that doesn’t work I have to white knuckle it until I’m back on schedule.
My MD lives in fear of prescribing renewals. Every time I ask for a refill he grills me. “Are you selling them? Are you buying from the street?
I am dependent on this pain killer, but that doesn’t make me an addict or a drug dealer. I can understand why some, the few, go to the street. Does the public and law enforcement want to chase these people or accept the reality that people in chronic pain need appropriate treatment?
On Sunday after noon . August 04. 2019 . while i were on my way to the laundromat on Buhre Avenue in the Bronx New York City , i met a young lady that i had got to known about three years ago at The Pelham Bay Branch Library Of The City of New York Public Library . on the street named Hobart Avenue , in The Bronx .N.Y.C . .Immediately she called out my name ,Trevor and was laughing along with asking how am i doing about fifteen feet before she came close to i . right away she told me that she and a gentleman will be doing a documentary on the Opioid Crisis . and if i would be willing to give her some advice . consultation and information as to how the whole issue or issues of the Opioid Epidemic began ? i right away smile laugh and spoke to myself inwardly . before telling her willing and eagerly .that i would most certainly and pleasantly do so . as i subscribed to and with A most wonderful and majestic institutional deeply and sophisticated in the The health Care Industry ., specifically . with the Drugs or Pharmaceutical Empires Industry ,my given name Pharmaceutical Empires for a extended time ago , due to the Crisis and Chaos Of Deaths That they have cause with the Pain Killers Or Opioid Issues and products , more so the Bribing of Doctors . .whereby these doctors . there in write prescriptions in tens upon tens of millions knowing fully well that the patient or patients does ,do not need them as they are use less yet still these doctors do so simply because of the Pharmaceutical Empires Money And Influence . yes that created this disaster here in and i Trevor Merchant are involved with this topic .,subject or issue ., profoundly ,extensively ,religiously and everlastingly with the impacts that which are affecting humanity globally . ,Opioids or Pain Killers , called them what you may . So here it is today , Tuesday . August . 06, 2019 A clear and comprehensive .factual example of what we spoke on a few days ago . .right here on stat . more to come . ,Trevor . 4. 57 p.m daylight savings time . N.Y.C