Naloxone Use: How to Save a Life


The Centers for Disease Control and Prevention (CDC) recommends opioids be used when benefits outweigh the risks, at the lowest effective dose, for the shortest duration possible, and after non-opioid therapies have been utilized.1 When opioids are warranted, co-prescribing naloxone can help prevent opioid overdose deaths. However, there are barriers to maximizing the utilization of naloxone such as community access, limited awareness of outpatient prescribing, uncertainty of patient overdose experiences, and stigma.2,3 The information below discusses ways to expand naloxone use.

Illinois Naloxone Standing Order

Primary barriers to naloxone use are access and availability.4 In 2015, the Illinois legislature passed Public Act 99-0480, which made naloxone more readily available to trained pharmacists and first responders for the treatment of opioid overdose.5,6 Subsequently in 2017, the Illinois Naloxone Standing Order was implemented to allow naloxone to be available through pharmacists, pharmacies, and overdose education and naloxone distribution (OEND) programs and available to the public with or without a prescription.

Additional information regarding the naloxone standing order, where patients can obtain naloxone, and the available dosage forms is available at https://illinoisadvance.com/what-illinois-naloxone-standing-order-and-how-does-patient-obtain-naloxone-pharmacy-without-prescription-what-naloxone-dosage-forms-are-available/


Outpatient Naloxone Prescribing

Another barrier to naloxone use is the lack of naloxone prescribing by clinicians beyond its traditional use in hospitals and emergency service settings.2,3 Increasing awareness of the role primary care prescribers play can aid in greater use of naloxone. During pain management appointments, clinicians can discuss the risk factors for opioid overdose, as well as the safety benefits of co-prescribing naloxone in all patients at increased risk of overdose, with both patients and caregivers.1-4 Common risk factors include those listed below.1,7

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Stigma Associated With Naloxone

Another barrier is the stigma associated with co-prescribing naloxone with opioids.3,8 Some prescribers expressed discomfort with prescribing naloxone because they did not want to offend patients, create a “false sense of security” for patients, or receive poor satisfaction ratings.2,3 Patients may also have concerns about themselves and public perception when given a prescription for naloxone.3 Clinicians can use this opportunity to discuss opioid overdose risks with their patients.4 Having the conversation with thoughtful language can help patients understand the value of naloxone without feeling judged or becoming guarded.2,8


Communication With Patients

The word “overdose” may have negative connotations for those taking prescription opioids. Consider alternative language such as “accidental overdose,” “bad reaction,” or “opioid safety” to destigmatize opioid safety.


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Let's talk about naloxone.png

For more examples of destigmatizing language when talking to patients about naloxone:

https://naloxonesaves.org/wp-content/uploads/sites/19608/2020/02/APhA-LetsTalkAboutNaloxone.pdf


Summary

The ongoing opioid epidemic created a place in therapy for naloxone to mitigate the risk of fatal overdose. Prescribers may consider co-prescribing naloxone for those at high risk of opioid overdose. To support use and widespread distribution, the Illinois naloxone standing order made the life-saving medication more accessible to the community. Lastly, reducing the stigma around naloxone use by implementing patient-centered language can make a difference in the acceptance and maximum utilization of naloxone.


  1. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. JAMA. 2016;315(15):1624-1645. doi:10.1001/jama.2016.1464
  2. 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. doi: 10.1007/s11606-015-3394-3
  3. Balancing societal and individual benefits and risks of prescription opioid use. In: National Academies of Sciences, Engineering, and Medicine. Pain management and the opioid epidemic. Washington, DC: The National Academies Press (US); 2017 July 13. DOI: https://doi.org/10.17226/24781
  4. Green TC, Bowman SE, Zaller ND, Ray M, Case P, Heimer R. Barriers to medical provider support for prescription naloxone as overdose antidote for lay responders. Subst Use Misuse. 2013 May;48(7):558-567. DOI: 10.3109/10826084.2013.787099.
  5. Illinois Department of Human Services. Guidelines for implementation of an opioid overdose education and naloxone distribution (OEND) program. 2018. Accessed May 12, 2021. https://www.dhs.state.il.us/OneNetLibrary/27896/documents/2018_DOPP_Guidelines_for_Implementation.pdf
  6. Illinois naloxone standardized procedure. Illinois Department of Public Health. September 2017. Accessed March 20, 2021. http://www.dph.illinois.gov/sites/default/files/Naloxone-SO-Procedures.pdf
  7. Opioid overdose. World Health Organization. Accessed May 13, 2021. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
  8. Tsai AC, Kiang MV, Barnett ML, Beletsky L, Keyes KM, McGinty EE, et al. Stigma as a fundamental hindrance to the Unites States opioid overdose crisis response. PLoS Med. 2019 Nov 26;16(11):e1002969. doi: 10.1371/journal.pmed.1002969.
  9. Let’s talk about naloxone – it saves lives. American Pharmacists Association. Accessed May 12, 2021. https://naloxonesaves.org/wp-content/uploads/sites/19608/2020/02/APhA-LetsTalkAboutNaloxone.pdf
  10. San Francisco Department of Public Health. Naloxone for opioid safety: a provider’s guide to prescribing naloxone to patients who use opioids. January 2015. Accessed May 13, 2021. https://www.chcf.org/wp-content/uploads/2017/12/PDF-NaloxoneOpioidSafetyProviders.pdf


Prepared by:

Tara Gallagly, PharmD
Clinical Pharmacist, Academic Detailer
University of Illinois Chicago College of Pharmacy

Nerissa Caballes, PharmD, MS, CRC
Supervisor, Academic Detailer
University of Illinois Chicago College of Pharmacy

The information presented is current as of October 2021. This information is intended as an educational piece and should not be used as the sole source for clinical decision making.