Should Naloxone Be Prescribed for Patients Taking Opioids for Chronic Pain?

Authors: Walley AY and Green TC., Ann Intern Med 2016 Jun 28;

Coprescribing naloxone was associated with fewer opioid-related emergency room visits.

Many communities that use targeted distribution of the short-acting opioid antagonist naloxone to reverse unintentional opioid overdoses have seen declines in community-level opioid overdose–related mortality. In this observational study from six “safety net” clinics in San Francisco, researchers evaluated the feasibility and effect of coprescribing naloxone to primary care patients who were taking opioids for chronic pain. Providers and clinic staff were trained on indications for prescribing naloxone and how to educate patients about naloxone use.

Among 1985 patients who were receiving long-term opioids (most commonly, oxycodone), 33% were prescribed naloxone as well. Patients who received naloxone coprescriptions were more likely to have visited emergency departments (EDs) previously for opioid-related reasons and to be taking higher doses of opioids. During 12 months after naloxone coprescription, patients who were prescribed naloxone versus those who were not made 63% fewer opioid-related ED visits.

Comment Naloxone coprescription in this primary care setting was associated with fewer opioid-related ED visits. Although this study demonstrates the feasibility of implementing such a strategy, it was not designed to identify how naloxone lowered the number of ED visits; for example, data on actual naloxone use were unavailable. Nonetheless, the findings are consistent with recent CDC guidelines that recommend that naloxone prescription be considered for patients with histories of overdose, substance use disorders, opioid doses of ≥50 MEQ (morphine equivalents) daily, or concurrent benzodiazepine use.