Thinking of expanding naloxone access? Here’s one way to increase prescribing

July 12, 2022

As states begin to make spending decisions for their opioid litigation funds, many may choose to broaden access to naloxone, a medication that reverses opioid overdoses. Increasing access to naloxone is the one of the Core Strategies, or approved uses, that jurisdictions are encouraged to adopt as part of the settlement agreements with Johnson & Johnson and the three largest opioid distributors.

States and local jurisdictions have used a number of approaches to increase access to naloxone, including standing orders so that anyone can get naloxone at the pharmacy without a prescription. Research has also shown the value of giving a prescription for naloxone to people at high-risk of an opioid overdose. However, naloxone prescription rates have remained low. To address this, California passed Assembly Bill 2770 in 2018. The bill requires that prescribers offer a prescription for naloxone whenever one or more of the following conditions is met:

1. The patient is receiving a high dose of opioids (more than 90 morphine milligram equivalents per day);
2. The patient is prescribed both an opioid and a benzodiazepine; or
3. The patient has an increased risk of overdose (for example, he or she has a history of an overdose or a history of a substance use disorder).

To facilitate adoption of this law, Kaiser Permanente Southern California incorporated a set of prompts for clinicians into the electronic health record that were triggered whenever one of the above conditions were met. These prompts reminded providers of the risks of opioid prescribing, the need to offer naloxone, and other recommended actions.

The effect of this decision-support tool was dramatic. Before the prompts were implemented, naloxone was prescribed at approximately 1% of the visits that met the criteria under the law. After the prompts were implemented, the rate of naloxone prescribing increased to over 25%. The researchers also found decreases in opioid prescribing and co-prescribing of naloxone and benzodiazepines after the prompts were implemented, likely due to the alerts as well.

Increasing the supply of naloxone in the community is an important tool to reduce opioid overdose deaths. In planning for litigation spending, state and localities should implement policies and programs to achieve this goal.