Association of Opioid Overdose Risk Factors and Naloxone Prescribing in US Adults
Prescribing naloxone to patients is a key strategy to prevent opioid overdoses, but little is known about the reach of naloxone prescribing.
Determine patient factors associated with receiving naloxone and trends over time in patients with key overdose risk factors.
Retrospective observational study.
Using the Clinformatics DataMart, a US-wide health insurance claims dataset, we compared adults who received opioids and naloxone (opioid+naloxone) from January 2014 to June 2017 with adults who received opioids without naloxone (opioids only), matched on gender, age ± 5 years, month/year of opioid fill, and number of opioid claims.
Key patient-level opioid overdose risk factors included receipt of high-dosage opioids, concurrent benzodiazepines, history of opioid and other substance use disorders, and history of opioid overdose.
We included 3963 opioid+naloxone and 19,815 opioid only patients. Key factors associated with naloxone fills included high opioid daily dosage (50 to < 90 morphine milligram equivalents (MME): AOR = 2.43, 95% CI 2.15–2.76 and ≥ 90 MME: AOR = 3.94, 95% CI 3.47–4.46; reference: < 50 MME), receiving concurrent benzodiazepines (AOR = 1.27, 95% CI 1.16–1.38), and having a diagnosis of opioid use disorder (AOR = 1.56, 95% CI 1.40–1.73). History of opioid overdose was not associated with naloxone (AOR = 0.92, 95% CI 0.74–1.15). The percent of patients receiving naloxone increased, yet less than 2% of patients in any of the key overdose risk factor groups received naloxone by the last 6 months of the study period.
Naloxone prescribing has increased and was more likely to be co-prescribed to patients with some risk factors for overdose. However, overall prescribing remains minimal. Additional efforts are needed across health systems to increase naloxone prescribing for patients at risk for opioid overdose.
KEY WORDS: overdose prevention naloxone opioids opioid use disorder
This work was supported by Precision Health at the University of Michigan, National Institute on Drug Abuse (grant R01 DA042859), and Substance Abuse and Mental Health Services Administration and Michigan Department of Health and Human Services. Dr. Lin was supported in part by a Career Development Award (CDA 18-008) from the US Department of Veterans Affairs Health Services Research & Development Service.
Compliance with Ethical Standards
Conflict of Interest
Dr. Brummett reported holding a patent for peripheral perineural dexmedetomidine licensed to the University of Michigan, being a consultant for Recro Pharma and Heron Therapeutics, and receiving research funding from Neuros Medical. All remaining authors declare that they do not have a conflict of interest.
The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript and decision to submit the manuscript for publication.
- 1.Hedegaard H., Minino A.M., Warner M. Drug Overdose Deaths in the United States, 1999-2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics; 2018.Google Scholar
- 7.Office of the Surgeon General; US Department of Health and Human Services. Surgeon General’s Advisory on Naloxone and Opioid Overdose. http://www.surgeongeneral.gov. Accessed August 23, 2019.
- 17.Optum. https://www.optum.com/content/dam/optum/resources/productSheets/5302_Data_Assets_Chart_Sheet_ISPOR.pdf. Accessed August 23, 2019.
- 20.Centers for Disease Control and Prevention. Opioid Morphine Equivalent Conversion Factors. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Opioid-Morphine-EQ-Conversion-Factors-March-2015.pdf. Accessed August 23, 2019.
- 22.Oliva EM, Bowe T, Tavakoli S, et al. Development and applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide. Psychol Serv. 2017;14(1):34-49. https://doi.org/10.1037/ser0000099.CrossRefPubMedGoogle Scholar
- 28.Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM. Overdose education and naloxone for patients prescribed opioids in primary care: a qualitative study of primary care staff. J Gen Intern Med. 2015;30(12):1837-1844. https://doi.org/10.1007/s11606-015-3394-3.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Winograd RP, Davis CS, Niculete M, Oliva E, Martielli RP. Medical providers’ knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within Veterans Affairs health care medical treatment settings. Subst Abus. 2017;38(2):135-140. https://doi.org/10.1080/08897077.2017.1303424.CrossRefPubMedGoogle Scholar
- 30.Ashrafioun L, Gamble S, Herrmann M, Baciewicz G. Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods. Subst Abus. 2016;37(1):76-81. https://doi.org/10.1080/08897077.2015.1110550.CrossRefPubMedGoogle Scholar
- 31.Kerensky T, Walley AY. Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know. Addict Sci Clin Pract. 2017;12. https://doi.org/10.1186/s13722-016-0068-3.
- 32.PDAPS - Naloxone Overdose Prevention Laws. http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139. Accessed August 23, 2019.