Bottom Line: A study based on a national database of private insurance claims suggests few patients at high risk of opioid overdose receive prescriptions for naloxone, which can reverse an overdose, during encounters with the health care system from hospitalizations and emergency department visits to physician visits. Among 138,108 high-risk patients, only 2,135 (1.5 percent) were prescribed naloxone. A greater likelihood of receiving naloxone was associated with prior diagnoses of opioid misuse or dependence and overdose compared to those diagnoses without overdose. A prior diagnosis of opioid overdose alone was associated with decreased likelihood of receiving naloxone compared with a prior diagnosis of opioid misuse or dependence without overdose. Study authors acknowledge their results underestimate the distribution and use of naloxone because many patients get it through programs where insurance isn't billed or patients may pay out of pocket. The study findings also may not be generalized to patients covered by Medicaid, some Medicare plans or those who are uninsured. Still, understanding barriers, such as a lack of awareness of local laws, to physician prescribing of naloxone to high-risk patients is important so that health care encounters aren't missed opportunities to provide the medication.
Authors: Mai T. Pho, M.D., M.P.H., of the University of Chicago Medicine, and coauthors
(doi: 10.1001/jamanetworkopen.2019.3209)
Editor's Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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