Naloxone should be coprescribed to high-risk patients, say federal agencies
https://www.pharmacytoday.org/article/S1042-0991(19)30239-7/fulltext
The U.S. Surgeon General wants naloxone to be in the hands of more people and has openly urged physicians to prescribe it. Now, federal agencies are following this lead with their own calls to action. The Department of Health and Human Services (HHS) recently announced a recommendation for clinicians to coprescribe naloxone to high-risk patients. This includes, but is not limited to, patients who are on relatively high doses of opioids or take other medications along with opioids, as well as patients with opioid use disorder.
The HHS recommendation comes on the heels of an FDA advisory panel’s vote late last year in favor of changing the label for opioids that should be coprescribed with naloxone.
But how much is known about the benefits of coprescribing naloxone, and what should pharmacists keep in mind?
State mandates
Several states, including Arizona, Florida, Rhode Island, Virginia, and Vermont, have laws mandating that clinicians coprescribe naloxone with opioids.
At the FDA advisory panel meeting last year, Jeffrey Bratberg, PharmD, clinical professor at the University of Rhode Island College of Pharmacy in Kingston, presented data based on Rhode Island’s recent mandate to coprescribe naloxone, which followed other measures the state already had in place to make naloxone more widely available.
“We are kind of the perfect storm here in Rhode Island to increase access to naloxone given everything else we have done leading up to coprescribing,” said Bratberg.
There is a standing order for naloxone in almost every pharmacy in the state as well as mandated insurance coverage for naloxone. “But it was really this [coprescribing] policy that has pushed up the amount of naloxone going out,” Bratberg said.
Since the coprescribing mandate in Rhode Island went into effect last summer, more naloxone has been dispensed from pharmacies in 5 months than in the past 2 years, according to Bratberg.
“We’d all love to follow the Surgeon General’s recommendation to carry this, but not everyone can if they have financial barriers [or] insurance coverage barriers, or they go to their pharmacy and it’s just not stocked due to stigma,” he said.
The main concern about making coprescribing a federal mandate—if that were a possibility—would be the potential increase to annual health care costs, a concern that was also brought up during the FDA meeting. In addition to coprescribing, the FDA meeting focused on other ways to make naloxone more widely available, such as creating a low-cost OTC naloxone product.
FDA said earlier this year that it would help make development of OTC naloxone easier for drug manufacturers. From an accessibility standpoint this sounds hopeful, but questions remain about the costs to patients if an OTC naloxone product is highly priced and if insurance coverage is no longer an option.
Destigmatizing
Most pharmacists are aware of the stigma associated with naloxone and why it might lead patients to abandon a naloxone prescription out of fear of being shamed. Providing education to patients about why they are at risk can help get past some of that.
“I think it’s important to be very specific,” said Anita Jacobson, PharmD, clinical professor at the University of Rhode Island School of Pharmacy. Jacobson uses motivational interviewing when talking to patients about naloxone and their opioid prescriptions, and she makes sure to let them know specifically—based on other medications they are taking or underlying medical conditions they may have—why they are at risk and should have naloxone on hand.
Pharmacists and clinicians prescribing naloxone also have to be on the same page.
“It’s an easier conversation for a pharmacist to say, ‘Your provider thinks you should have this prescription, and I agree,’ versus the recommendation coming straight from the pharmacist,” said Bratberg.
In Rhode Island, Jacobson said, the coprescribing mandate has given pharmacists an opportunity to work more closely with physicians and other prescribers. Because many prescribers are scrambling to make sure they are compliant with the mandate, continuing education (CE) for these groups has been in demand. Prescribers in Rhode Island have requested that pharmacists provide the CE, whether it’s in a classroom or through a webinar.
Bratberg has noticed something else since coprescribing was mandated in Rhode Island.
“Instead of a pharmacist dispensing an average of one naloxone [prescription] a week, now they are dispensing one every day, so that means it’s always in stock, it’s available, and this increased exposure destigmatizes it,” he said.
Filed under: General Problems
Also, as far as “I” am aware, my drs had no direct involvement in this, all part of the Pharmacist Job, whether at his discretion, or Provincial Mandate hopefully, to all who have a opiate Rx long term. The people on the frontline, emergency services, also pass them out as needed I believe. No Rx involved that I saw, tho a record was kept in my case.
It needs to be anywhere opioids are, or where users, street or otherwise, congregate. Nobody is going to get “high” on it, it’s the high killer, so they’re more likely to be pissed theirs has been ruined. Oblivion seekers do. Lack of Hope for a better future is at the root of that. We have work to do as a society, but, it is a Sociological and Medical problem, not a criminal one. Using that route to control just Kills hope. It’s a circle jerk that we’re Finally trying to avoid. That’s Hope.
b.
In Canada, Ontario specifically, I was asked by the pharmacist if I Wanted a Naloxone kit, injector or nasal, to carry, store, or give away to someone else in need, then come in for as many replacements as I needed, as needed, for Free. I LiKE Canada!!!=8^D
Nice living in a Civilized country for a Change. Ya’ll have truly NO idea of the Weight taken off in All areas of Life, when Healthcare is a Right.
The USA is not yet anywhere near being a Civilized country. It is an experiment, true. One badly in need of Correction as it has turned into what it had a Revolution, that at least 36 of my ancestors took part in, to get away from. Wake Up, & Vote the Constitutional Violators & Perverters out of office. Or take up T. Jefferson’s remedy.
Tho the French solution is getting more & more attractive.
BHW
Huh? brucepoint on? Are you recreational drug user? Or do you enjoy profilimg chronic pain patients as irresponsible drug users?
Huh? Reading comprehension?
Wherever you pulled That out of, glad I’m not there.
For the record, again. I was talking with “My” Pharmacist, of 10 years + now, doing a quarterly med review. Not a “recreational user”, why would I be here otherwise?
Chronic Pain Survivor, 25+ years, spinal dislocation on multiple levels, Mining Accident in the good ol usa, making an honest, but hard living working for a “Self-Insured” Mining corp, USG. Took three & a half years to get into PM, because the corp was trying to get it’s “Self-Insured” Bond back from the state of California, because of self induced poison pill, to keep T. Boone Pickins & friends from taking over & firing the board. Went from a 23% employee owned company to a 0.5 % employee owned company in one fell swoop.
Screwed employees that had worked in that particular desert hellhole since the end of WWII to where they could Not retire.
Only alive now, because I married a Canadian in 2004, and we decided to stay in Canada, rather than Southern California, where we both had jobs lined up, her’s teaching, mine being the bouncer in the bin, in Neuropsych lockups, to keep my stuff in perspective. I took Care of irresponsible drug users, & learned from every one of them. So take your preconceived notions wherever you got them, & keep them to yourself, thank you.
b.