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.

Naloxone Access Laws

Primary barriers to naloxone use are access and availability.⁴ Currently, 50 states and the District of Columbia have implemented naloxone access laws to make naloxone more readily available for the treatment of opioid overdose.^5,6 The extent of access and protection given by these laws varies from state to state. However, naloxone is available in all states to dispense with or without a prescription by way of pharmacists’ prescriptive authority, standing orders, protocol orders, and/or collaborative practice agreements.

Additional information regarding state-specific laws and policies on naloxone access is available at

https://www.pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139

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

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.^9,10

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

https://georgiagerontologysociety.org/wp-content/uploads/2019/08/LetsTalkAboutNaloxone-1.pdf

Summary

The ongoing opioid epidemic created a place in therapy for naloxone to mitigate the risk of fatal overdose.¹ Prescribers may consider co-prescribing naloxone for those at high risk of opioid overdose. To support use and widespread distribution, naloxone access laws made the life-saving medication more accessible to communities in the United States.^5,6 Lastly, reducing the stigma around naloxone use by implementing patient-centered language can make a difference in the acceptance and maximum utilization of naloxone.^2,10

References

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
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
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
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
Preventing the consequences of opioid overdose: understanding naloxone access laws. Substance Abuse and Mental Health Services Administration’s Centers for the Application of Prevention Technologies. January 20, 2018. Accessed August 5, 2022. https://mnprc.org/wp-content/uploads/2019/01/naloxone-access-laws-tool.pdf
Naloxone overdose prevention laws. Prescription Drug Abuse Policy System. January 1, 2022. Accessed August 5, 2022. https://www.pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139
Opioid overdose. World Health Organization. Accessed August 4, 2022. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
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
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 August 4, 2022. https://www.chcf.org/wp-content/uploads/2017/12/PDF-NaloxoneOpioidSafetyProviders.pdf
Let’s talk about naloxone – it saves lives. American Pharmacists Association. Accessed August 4, 2022. https://georgiagerontologysociety.org/wp-content/uploads/2019/08/LetsTalkAboutNaloxone-1.pdf