State Mandates On Naloxone Coprescribing Associated With Short-Term Increase In Naloxone Codispensing

Area of Science:

• Public Health
• Pharmacology
• Health Policy

Background:

• The US opioid crisis necessitates strategies to reduce overdose fatalities.
• Naloxone coprescribing mandates aim to increase access to overdose reversal medication for at-risk patients.
• Identifying at-risk populations includes those on high opioid dosages, using benzodiazepines, or with substance use disorder/overdose history.

Purpose of the Study:

• To investigate changes in naloxone coprescribing rates among high-risk patients post-mandate implementation.
• To assess the longitudinal impact of state-level naloxone coprescribing mandates on overdose risk mitigation.

Main Methods:

• Analysis of a national, multipayer patient cohort receiving prescription opioids (2016-2021).
• Controlled interrupted time series analysis to evaluate mandate effects in ten implementing states.
• Focus on patients identified as having an elevated risk for overdose.

Main Results:

• Significant immediate increase in naloxone coprescribing observed in eight of ten states following mandate implementation.
• Subsequent downward trend in codispensing rates noted in five of these states after the initial rise.
• Variability in mandate effectiveness and sustainability across different states.

Conclusions:

• State mandates can initially boost naloxone coprescribing for at-risk opioid users.
• Mandates alone may be insufficient for achieving sustained increases in naloxone access.
• Additional strategies are required to enhance and maintain the impact of mandates in addressing the overdose crisis.