NALOXONE CO-PRESCRIBING

Naloxone can be a life-saving medication. Prescribers should consider co-prescribing naloxone in the following clinical scenarios:

50 MME/DAY

If you are prescribing an opioid, individually, or in aggregate with, other medications, greater than or equal to 50 MME/day, consider co-prescribing naloxone.

BENZODIAZEPINES AND OPIOIDS

If you are prescribing any dose of opioid when a benzodiazepine has been prescribed in the past 30 days or will be prescribed at the current visit, consider co-prescribing naloxone.

OPIOID USE DISORDER OR OVERDOSE HISTORY

If you are prescribing any dose of an opioid to a patient with a prior history of opioid use disorder (OUD) or overdose, consider co-prescribing naloxone.

If co-prescribing is not appropriate for the patient, the prescriber should document the reason(s) in the patient’s medical record.

OTHER CONSIDERATIONS

You should also consider co-prescribing naloxone if the patient presents with any of the following conditions:

  • Suspected or known heroin or non-medical opioid use
  • Buprenorphine or methadone maintenance
  • Changing from one opioid to another
  • Living in remote location or difficulty accessing EMS
  • Request from patient or concerned significant other

Or if the patient is receiving an opioid prescription in combination with:

  • Smoking, COPD, asthma, sleep apnea, respiratory infection, other respiratory illness
  • Renal disease, liver disease, cardiac disease, HIV/AIDS
  • Known or suspected heavy alcohol use
  • Concurrent antidepressant prescription
  • Recently released from incarceration, detoxification or mandatory abstinence programs

TRENDS IN NALOXONE DISPENSING

12.9

Among prescriber specialties, psychiatrists have the highest rate of co-prescribed naloxone per 100 high-dose opioid prescriptions (12.9), followed by addiction medicine specialists and pediatricians.

Source: CDC

106%

The number of naloxone prescriptions dispensed from retail pharmacies increased by 106% from 2017 to 2018.

Source: CDC

BEST PRACTICES FOR CO-PRESCRIBING

Some research shows that even when naloxone prescriptions are not filled, the patient's risk of overdose decreases because the prescription appears to serve as a patient education tool.

CHECK K-TRACS

Check K-TRACS for the patient's prescription drug history and any concerning prescribing history including more than 50 MME per day or long-acting opioid use.

ASK ABOUT PREVIOUS NALOXONE USE

Ask the patient about previous naloxone use. Naloxone administered in an emergency room will not appear in K-TRACS because Kansas does not require reporting.

SCREEN FOR SUBSTANCE USE

Use Screening, Brief Intervention and Referral to Treatment (SBIRT) to screen for substance use that could impact opioid use.

SCREEN FOR COMBINATION USE

Screen patients to identify potential harmful opioid use in combination with benzodiazepines, alcohol, antidepressants and/or sedatives.

CO-PRESCRIBING RESOURCES