Naloxone receipt following nonfatal opioid poisoning among Medicaid beneficiaries

Despite naloxone's proven effectiveness in reversing opioid poisoning, receipt rates among the high-risk Medicaid population remain insufficient and the patient- and system-level characteristics associated with this gap are poorly understood.

To describe the patient-and system-level characteristics associated with a naloxone prescription fill within 7 days of a nonfatal opioid poisoning among Medicaid beneficiaries.

Using the Merative™ MarketScan Multi-State Medicaid Database (2018-2022), we identified adult (≥18 years) beneficiaries with a nonfatal opioid poisoning. The primary outcome was a naloxone prescription claim within 7 days of the index poisoning. Multivariable logistic regression characterized associations between beneficiary characteristics and naloxone prescription fill. Robustness was assessed using last-event indexing RESULTS: Among 64,332 beneficiaries (mean [SD] age 38.6 [12.1] years), 2590 (4.0%) received naloxone within 7 days. After adjustment, the odds of naloxone receipt were higher among Black (adjusted odds ratio [aOR] 1.26, 95% CI 1.13-1.41) and Hispanic (aOR 1.22, 95% CI 1.01-1.47) beneficiaries relative to White, and among those with a prior mental health disorder (aOR 1.23, 95% CI 1.12-1.34). Greater comorbidity was associated with higher odds relative to a Charlson score of 0 (1-2: aOR 1.14, 95% CI 1.03-1.25; 3-4: aOR 1.23, 95% CI 1.05-1.45 and 1.20, 95% CI 1.01-1.42). Odds were lower among older beneficiaries, particularly those aged ≥65 years (aOR 0.33, 95% CI 0.22-0.48), and those in capitated (managed care) plans (aOR 0.57, 95% CI 0.53-0.62). Findings were largely consistent across the sensitivity analysis. Prior opioid poisoning, more common under last-event indexing (≥1 episode in 65.5%, vs. 0.8%), was not associated with naloxone receipt (aOR 1.04, 95% CI 0.96-1.11).

Naloxone remains underprescribed for Medicaid beneficiaries after nonfatal opioid poisoning, with receipt varying by demographic, clinical, and insurance characteristics. Timely naloxone should be offered to all in need, regardless of patient or system characteristics.