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. 2019 Jun 5;2(6):e196215.
doi: 10.1001/jamanetworkopen.2019.6215.

Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States

Minji Sohn  1 , Jeffery C Talbert  2 , Zhengyan Huang  3 , Michelle R Lofwall  4 , Patricia R Freeman  2
Affiliations

Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States

Minji Sohn et al. JAMA Netw Open. .

Abstract

Importance: To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients.

Objective: To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies.

Design, setting, and participants: This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA's national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month and the study period was January 1, 2011, to December 31, 2017.

Exposures: State legal intervention mandating naloxone coprescription.

Main outcomes and measures: Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated.

Results: The rate of naloxone dispensing increased after implementation of legal mandates for naloxone coprescription. 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. In comparison, 16 naloxone prescriptions per 100 000 were dispensed in the 10 states (including the District of Columbia) with the highest opioid overdose death rates and 6 prescriptions per 100 000 were dispensed in the 39 remaining states. The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22-49.35). Implementation of the naloxone coprescription mandate was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates, holding all other variables constant. 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), the percentage of naloxone prescriptions paid by third-party payers (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.

Conclusions and relevance: These study findings suggest that legally mandated naloxone prescription for those at risk for opioid overdose may be associated with substantial increases in naloxone dispensing and further reduction in opioid-related harm.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Talbert reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Lofwall reported receiving grants and personal fees from Braeburn Pharmaceuticals, and personal fees from Indivior and CVS Caremark outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Naloxone Prescription Dispensing Rates per 100 000 Standard Population, 2011-2017
Legal requirements for naloxone coprescription became effective on March 15 and July 1, 2017, in Virginia and Vermont, respectively (shown as vertical lines on graph). The top 10 states (including the District of Columbia [DC]) with opioid-related overdose deaths include West Virginia, New Hampshire, Ohio, DC, Massachusetts, Maryland, Rhode Island, Maine, Connecticut, and Kentucky.
See this image and copyright information in PMC

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