State Laws That Require Coprescribing Opioids and Naloxone and Codispensing Practices

Area of Science:

• Public Health
• Pharmacology
• Health Policy

Background:

• Opioid overdose deaths remain a significant public health crisis.
• Coprescribing naloxone with opioid prescriptions is a strategy to reduce overdose risk.
• Eight U.S. states enacted laws mandating naloxone coprescribing by the end of 2020.

Purpose of the Study:

• To evaluate the impact of state laws mandating naloxone coprescribing on actual medication dispensing practices.
• To quantify changes in the proportion of opioid prescriptions filled concurrently with naloxone prescriptions.

Main Methods:

• Utilized augmented synthetic control analyses on commercial insurance data (2014-2020).
• Examined the effect of 8 state coprescribing laws implemented between 2017 and 2020.
• Focused on the proportion of opioid prescription fills accompanied by a naloxone coprescription fill.

Main Results:

• Laws in 4 states (New Jersey, New Mexico, Rhode Island, Virginia) were associated with statistically significant increases in naloxone coprescribing.
• Observed increases ranged from 0.8 to 4.4 percentage points in these states (p<0.05).
• No significant changes in coprescribing were detected for laws in Arizona, Florida, Vermont, and Washington.

Conclusions:

• Mandatory naloxone coprescribing laws are associated with modest increases in concurrent dispensing in some states.
• To enhance impact, consider broadening the scope of opioid prescriptions covered by these laws.
• Implementing health system strategies to promote provider adoption of coprescribing is recommended.