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. 2022 Aug;37(11):2624-2633.
doi: 10.1007/s11606-021-07356-6. Epub 2022 Feb 7.

Naloxone Co-Dispensing with Opioids: a Cluster Randomized Pragmatic Trial

Ingrid A Binswanger  1   2   3   4 , Deborah Rinehart  5   6 , Shane R Mueller  7 , Komal J Narwaney  7 , Melanie Stowell  6 , Nicole Wagner  7   5 , Stan Xu  8 , Rebecca Hanratty  5   9 , Josh Blum  5   9 , Kevin McVaney  9 , Jason M Glanz  7   10
Affiliations

Naloxone Co-Dispensing with Opioids: a Cluster Randomized Pragmatic Trial

Ingrid A Binswanger et al. J Gen Intern Med. 2022 Aug.

Abstract

Background: Although naloxone prevents opioid overdose deaths, few patients prescribed opioids receive naloxone, limiting its effectiveness in real-world settings. Barriers to naloxone prescribing include concerns that naloxone could increase risk behavior and limited time to provide necessary patient education.

Objective: To determine whether pharmacy-based naloxone co-dispensing affected opioid risk behavior. Secondary objectives were to assess if co-dispensing increased naloxone acquisition, increased patient knowledge about naloxone administration, and affected opioid dose and other substance use.

Design: Cluster randomized pragmatic trial of naloxone co-dispensing.

Setting: Safety-net health system in Denver, Colorado, between 2017 and 2020.

Participants: Seven pharmacies were randomized. Pharmacy patients (N=768) receiving opioids were followed using automated data for 10 months. Pharmacy patients were also invited to complete surveys at baseline, 4 months, and 8 months; 325 survey participants were enrolled from November 15, 2017, to January 8, 2019.

Intervention: Intervention pharmacies implemented workflows to co-dispense naloxone while usual care pharmacies provided usual services.

Main measures: Survey instruments assessed opioid risk behavior; hazardous drinking; tobacco, cannabis, and other drug use; and knowledge. Naloxone dispensings and opioid dose were evaluated using pharmacy data among pharmacy patients and survey participants. Intention-to-treat analyses were conducted using generalized linear mixed models accounting for clustering at the pharmacy level.

Key results: Opioid risk behavior did not differ by trial group (P=0.52; 8-month vs. baseline adjusted risk ratio [ARR] 1.07; 95% CI 0.78, 1.47). Compared with usual care pharmacies, naloxone dispensings were higher in intervention pharmacies (ARR 3.38; 95% CI 2.21, 5.15) and participant knowledge increased (P=0.02; 8-month vs. baseline adjusted mean difference 1.05; 95% CI 0.06, 2.04). There was no difference in other substance use by the trial group.

Conclusion: Co-dispensing naloxone with opioids effectively increased naloxone receipt and knowledge but did not increase self-reported risk behavior.

Trial registration: Registered at ClinicalTrials.gov ; Identifier: NCT03337100.

Keywords: naloxone; overdose; prescription opioids; risk compensation; substance use.

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Conflict of interest statement

Outside of the listed affiliations, I.B. reports royalties from UpToDate, and all remaining authors declare that they do not have a conflict of interest.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) diagram of screening, enrollment, and follow-up of patients and survey participants
See this image and copyright information in PMC

Comment in

References

    1. Davis C, Carr D. State legal innovations to encourage naloxone dispensing. J Am Pharm Assoc. 2003;57(2):S180–S4. doi: 10.1016/j.japh.2016.11.007. - DOI - PubMed
    1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep. 2016;65(1):1–49. doi: 10.15585/mmwr.rr6501e1. - DOI - PubMed
    1. U.S. Department of Health and Human Services. HHS recommends prescribing or co-prescribing naloxone to patients at high risk for an opioid overdose. HHS.Gov. December 19, 2018. https://www.hhs.gov/about/news/2018/12/19/hhs-recommends-prescribing-or-.... Accessed 29 Sep 2021.
    1. Sohn M, Talbert JC, Huang Z, Lofwall MR, Freeman PR. Association of naloxone coprescription laws with naloxone prescription dispensing in the United States. JAMA Netw Open. 2019;2(6):e196215-e. doi: 10.1001/jamanetworkopen.2019.6215. - DOI - PMC - PubMed
    1. Guy GP, Jr, Haegerich TM, Evans ME, Losby JL, Young R, Jones CM. Vital signs: Pharmacy-based naloxone dispensing - United States, 2012-2018. MMWR Morb Mortal Wkly Rep. 2019;68(31):679–86. doi: 10.15585/mmwr.mm6831e1. - DOI - PMC - PubMed

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