Opioid Prescribing with Take-Home Naloxone: Rationale and Recommendations
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OPIOID USE IN AN OPIOID EPIDEMIC (S DALAL, SECTION EDITOR)
Opioid Prescribing with Take-Home Naloxone: Rationale and Recommendations Jaya Amaram-Davila 1 & Tarun Mallipeddi 2 & Akhila Reddy 1 Accepted: 14 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Although take-home naloxone is available for prescribing, recommended for certain high-risk patients, and can prevent overdose-related deaths, access to naloxone remains a challenge. This review describes the high-risk population on opioids that benefit from naloxone co-prescription, guidelines, and the current trends in naloxone prescribing, and the barriers faced by all the stakeholders. Recent Findings Opioid-related overdoses and deaths still occur at critically high numbers. Short-acting opioid antagonists like naloxone can reverse the effect of an overdose in a few minutes. The US Food and Drug Administration (FDA) approved naloxone nasal spray, and auto-injectable kits are both effective and easy to administer. An increasing number of states in the USA mandate the co-prescription of naloxone for patients on chronic opioid therapy, irrespective of the presence of other underlying risk factors. The lack of provider education is one of the significant barriers for co-prescribing naloxone with opioids. Summary Naloxone can be lifesaving in patients experiencing an opioid overdose. Providers are encouraged to co-prescribe take-home naloxone for high-risk patients on chronic opioid therapy. Understanding the barriers, creating awareness, and providing education can increase the prescription of take-home naloxone and help prevent opioid overdose-related deaths. Keywords Naloxone . Opioid use . Opioid overdose . Overdose-related death . Opioid epidemic
Introduction/Background Opioid-related deaths have increased by 400% in the last two decades [1••]. There were 67, 367 deaths related to drug overdoses in 2018, and 70% of those were related to opioids. Despite a slight decline in fatalities compared with 2017, there was a 10% increase related to synthetic opioids, mainly from illicitly manufactured rapid-acting fentanyl (IMF) and its analogs [2••]. Additionally, there are more than 1 million Jaya Amaram-Davila and Tarun Mallipeddi contributed equally to this work. This article is part of the Topical Collection on Opioid Use in an Opioid Epidemic * Akhila Reddy [email protected] 1
Department of Palliative, Rehabilitation, and Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
2
University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
overdose-related hospital visits every year [3, 4•]. The recent increase in overdose-related deaths related to the IMF and its analogs has underscored the importance of recognizing and quickly reversing opioid overdoses. Opioid overdoses are associated with respiratory depression leading to hypoxia, cardiac arrest, central nervous system depression, sedation, and death [2••, 5••, 6]. Naloxone administration for the reversa
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