Are state laws regarding naloxone access associated with reductions in fatal overdoses involving opioids? A systematic review of community opioid overdose prevention and naloxone distribution programs. Meanwhile, in July 2017, 16 naloxone prescriptions per 100 000 were dispensed in the top 10 states (including the District of Columbia) with OOD deaths and 6 prescriptions per 100 000 in the remaining states—all without mandated naloxone prescribing. Get free access to newly published articles. Quiz Ref IDIn the second full year after adoption, we estimated that direct-authority NALs were associated with 0.313 (95% CI, 0.148-0.478; P = .001) fewer opioid deaths per 100 000 people relative to the year before adoption. The rising price of naloxone: risks to efforts to stem overdose deaths. Findings  We estimated a linear specification using ordinary least squares, modeling the rate of opioid-involved deaths (and other outcomes) as a linear function of state fixed effects, year-month or year-quarter fixed effects, indicator variables related to NAL adoption for all 3 dimensions, and other covariates. Ruhm The evolution of prescription drug monitoring programs. Although the association with direct authority was large, it was not statistically significant at the 5% level.  DM, Smith  D.  State legal innovations to encourage naloxone dispensing. Reviewing state-mandated training requirements for naloxone-dispensing pharmacists. There are limitations to this study. State legal interventions that mandate naloxone coprescription for potentially at-risk patients may be associated with increases in naloxone prescription dispensing in retail pharmacies, and this strategy may be useful to improve naloxone availability and reduce opioid-related harm. We found less evidence of association between direct-authority NALs and heroin or methadone overdoses, but the patterns for the other opioids were similar to those presented herein (eAppendix in the Supplement). © 2020 American Medical Association. Results  This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.  PR, Hankosky  CJ. Most recently, Virginia and Vermont mandated the coprescription of naloxone to potentially at-risk patients, including those with a history of OOD or receiving high-dose opioids. Number of naloxone prescriptions dispensed. Our event study framework pinpoints the timing of the outcome, so these changes would have to occur at the same time as adoption of direct-authority NALs but be uncorrelated with adoption of all other types of NALs. Pauly The results from this analysis are presented in the eAppendix in the Supplement and are similar to the main estimates described in the article. Our results suggest that naloxone laws providing direct authority to pharmacists may be associated with reductions in opioid-related mortality. We considered statistical significance to be a 2-sided P value <.05. Even if naloxone is coprescribed with opioids, the patient may choose not to fill the naloxone prescription if it is not covered by a third-party payer. We consider such a coincidence unlikely. Hedegaard Meaning  The natural logarithm of state population was included as an offset term. The rising price of naloxone—risks to efforts to stem overdose deaths. Each indicator is equal to 0 for nonadopters.  BH, Ali The quarterly rate of Medicaid prescribing of naloxone, however, was not substantial, with only 0.046 prescriptions per 100 000 beneficiaries over the shorter 2010-2016 period (Table 2). VanHouten Author Contributions: Dr Sohn had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The changing landscape of naloxone availability in the United States, 2011–2017. Implementation of the naloxone coprescription mandate was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates, holding all other variables constant.  LJ.  JM. Although this study provides what we believe to be some of the first evidence of the role of pharmacists in the distribution of naloxone and its association with opioid overdoses, there are some limitations.  S, Delcher Prescription drug overdoses: a review. For example, using data from Symphony Health’s Pharmaceutical Audit Suite Prescription Monthly data, Xu et al9 showed that, in 2016, a total of 147 457 naloxone prescriptions were dispensed from retail pharmacies, which is approximately 46 per 100 000. We hypothesize that NALs granting direct authority to pharmacists to provide naloxone will have the greatest potential for reducing fatal overdoses. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients.  B. Number of States With NAL by Type, 2005-2016, Table 2. All Rights Reserved. Prescription Drug Abuse Policy System. Bachhuber Sohn M, Talbert JC, Huang Z, Lofwall MR, Freeman PR. Lee Communities in which access to naloxone is improved should prepare for increases in nonfatal overdoses and link these individuals to effective treatment. JAMA Network Open. Three policy indicators are constructed from these legal data: (1) an indicator if a state provides pharmacists with explicit permission to distribute naloxone either by providing them prescriptive authority or by explicitly allowing pharmacies to dispense naloxone without a prescription (direct authority), (2) an indicator if a state indirectly provides pharmacists the ability to dispense naloxone either through a standing order (ie, a professional group authorizes general dispensing to people who meet specific criteria) or a statewide protocol/standing order issued by a state health official for all licensed pharmacists (indirect authority), and (3) an indicator if a state has passed any other type of naloxone law providing legal protections other than laws captured in the first 2 categories. E, Jones TS, Gilbert MK, Davidson PJ ; Centers for Disease Control and prevention ( CDC.. 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