Naloxone: A Pain to Co-Prescribe? Evaluating naloxone co-prescribing practices for patients at an increased risk of opioid overdose at a federally qualified health center

Abstract

Specific Aims: Describe the population at high risk for opioid overdose that are receiving naloxone orders with concurrent prescriptions with a morphine milliequivalent (MME) ≥ 50, concurrent prescriptions for benzodiazepines or opioid use disorder, and/or a history of opioid overdose. Methods: This is a descriptive, observational, retrospective, cross-sectional study from October 2022 using data extracted from El Rio charts. To be eligible for this study, patients must have been treated at El Rio Clinic during October 2022, and meet certain Centers for Disease Control and Prevention (CDC) criteria for being at high risk for opioid overdose. A sample size of 773 was provided for data analysis. A total of 77 patients were excluded due to a lack of combined MME available, leaving a total of 696 patients analyzed. Results: Of the sample size analyzed (n=696), there were 367 naloxone orders prescribed. For MME >50, 238 patients were analyzed and 159 were prescribed concurrent naloxone (66.8%). For patients with medications used for opioid use disorder (OUD) and/or substance use disorder (SUD), 186 patients were analyzed and 130 were prescribed concurrent naloxone (69.9%). For patients with an OUD/SUD diagnosis, 239 patients were analyzed and 148 had concurrent naloxone (61.9%). For patients with concurrent benzodiazepines and opioids, 143 patients were analyzed and 65 had concurrent naloxone (45.4%). For patients with orders for benzodiazepines, muscle relaxants, and opioids, 75 patients were analyzed and 38 had concurrent naloxone (50.6%). Conclusions: There were 881 total opportunities to provide naloxone that met CDC recommendations. On average, 2 out of every 5 patients could have received naloxone that did not. Patients with OUD/SUD history or relevant medications were most commonly co-prescribed naloxone. The most overlooked group were those on opioids and benzodiazepines concurrently.