Comparison of Prescribing Patterns of Intranasal Naloxone in a Veteran Population

Naloxone is the most frequently prescribed antidote for opioid overdose. More than one-third of opioid overdose reversals involved ≥ 2 doses of intranasal naloxone 4 mg. While an 8 mg intranasal product is available, there are limited recommendations for the preferred dosage. This study reviews and analyzes data to determine if there is a difference in prescribing patterns for naloxone 4 mg and naloxone 8 mg at Veteran Health Indiana (VHI).

Patients prescribed naloxone 4 mg or 8 mg at VHI between April 1, 2022, and April 1, 2023, were included. The primary endpoint was prescribing patterns between naloxone 4 mg and naloxone 8 mg. Data collected included naloxone prescriptions by month, number of patients with repeated naloxone fills, discipline of prescriber, type of clinic, and reason for receiving naloxone.

One hundred one veterans were included in the study; 53.5% of veterans received a prescription for naloxone 8 mg, 41.6% for naloxone 4 mg, and 4.9% for both doses. Pharmacists prescribed the highest number of naloxone prescriptions regardless of dose, followed by nurse practitioners and physicians. Most naloxone prescriptions were written using the Stratification Tool for Opioid Risk Management initiative and primary clinics. Naloxone prescriptions were for chronic opioid use, opioid use disorder, and substance use disorder.

The absence of well-defined guidance regarding dosing for intranasal naloxone has led to disparate prescribing practices between prescriber disciplines, types of clinics, and indications for receiving naloxone. This study highlights the need for clinical guidelines with supporting evidence and institution-specific guidance.