Naloxone: More than Just a Rescue for Opioid Overdose
Michael Crooks, PharmD., Medication Safety Lead – Alliant Quality, Georgia’s Medicare Quality Improvement Organization
The Surgeon General Takes a Stand: In April 2018, Dr. Jerome Adams gave voice to the call for broad availability of the opioid overdose reversal agent naloxone in a recent advisory statement calling for more Americans to keep the medicine on-hand. Naloxone can temporarily reverse the effects of opioid overexposure, including respiratory depression, by blocking the activity of opioids at receptors in our central nervous system.
The Surgeon’s General statement was clear: more people should carry and learn to use the medicine – not just opioid users. Beyond those prescribed high doses of opioids and those misusing opioids, including heroin or fentanyl, the recommendation identifies friends and family members of opioid users along with health care providers and community members who encounter at-risk opioid users.
Opioid Prescribers and Dispensers Should be Naloxone Prescribers and Dispensers: Putting naloxone in the hands of every person included in this recommendation may be impractical – the cost alone for such a supply is prohibitive. Prescribers should, however, consider which of their opioid-using patients ought to be prescribed or counseled on the use of naloxone. Recommendations vary by care setting or specialty, but generally identify dose, duration, drug combinations and personal factors that can increase risk of opioid related harm.
Georgia Law accommodates several means of increasing access to naloxone by defining prescribing protocols and curtailing personal liability through the Medical Amnesty Law and implementing a standing order for pharmacies to initiate dispensing without a patient-specific prescription.
Naloxone is just a part of the opioid risk conversation: Recommending naloxone to patients can be beneficial, even if the medicine is not dispensed. A study in several primary care clinics showed reduction in opioid-related hospitalizations and emergency department use for individuals counseled on the use of naloxone versus those who were not. This improvement was independent of patients actually filling the naloxone prescription and occurred without significant change in the dose of opioids used. Patients, family members and caregivers are too often under informed on the risks of medication use, and a conversation about the possible benefit of another medicine as a “rescue” really brings the point home: opioids can be dangerous, even deadly.