College of Pharmacy, Ferris State University, Big Rapids, Michigan.
Institute for Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington.
JAMA Netw Open. 2019 Jun 5;2(6):e196215. doi: 10.1001/jamanetworkopen.2019.6215.
To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients.
To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies.
DESIGN, SETTING, AND PARTICIPANTS: This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA's national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month and the study period was January 1, 2011, to December 31, 2017.
State legal intervention mandating naloxone coprescription.
Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated.
The rate of naloxone dispensing increased after implementation of legal mandates for naloxone coprescription. An estimated 88 naloxone prescriptions per 100 000 were dispensed in Virginia and 111 prescriptions per 100 000 were dispensed in Vermont during the first full month the legal requirement was effective. In comparison, 16 naloxone prescriptions per 100 000 were dispensed in the 10 states (including the District of Columbia) with the highest opioid overdose death rates and 6 prescriptions per 100 000 were dispensed in the 39 remaining states. The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22-49.35). 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. Among covariates, naloxone access laws (IRR, 1.37; 1.05-1.78), opioid overdose death rates (IRR, 1.06; 95% CI, 1.04-1.08), the percentage of naloxone prescriptions paid by third-party payers (IRR 1.009; 1.008-1.010), and time (IRR, 1.06; 95% CI, 1.05-1.07) were significantly associated with naloxone prescription dispensing.
These study findings suggest that legally mandated naloxone prescription for those at risk for opioid overdose may be associated with substantial increases in naloxone dispensing and further reduction in opioid-related harm.
为了减轻阿片类药物过量危机，各州已实施了各种旨在增加阿片类药物拮抗剂纳洛酮获取途径的法律干预措施。最近，弗吉尼亚州和佛蒙特州规定为有潜在风险的患者共同开具纳洛酮处方。
评估纳洛酮共同处方法律授权与零售药店纳洛酮配药之间的关联。
设计、地点和参与者：这是一项基于人群的州级队列研究。该样本包括 IQVIA 全国处方审计中零售药店环境中开出的所有纳洛酮处方，占美国所有零售药店的 90%。观察单位为州-月，研究期间为 2011 年 1 月 1 日至 2017 年 12 月 31 日。
州法律干预措施要求共同开具纳洛酮处方。
开出的纳洛酮处方数量。每月每 10 万标准人群开出的纳洛酮处方数计算。
在实施共同开具纳洛酮处方的法律授权后，纳洛酮的配药率有所增加。在法律要求生效的第一个整月，弗吉尼亚州开出了约 88 份纳洛酮处方，佛蒙特州开出了 111 份处方。相比之下，在阿片类药物过量死亡率最高的 10 个州（包括哥伦比亚特区），开出了 16 份纳洛酮处方，在其余 39 个州开出了 6 份处方。开出的纳洛酮处方数量与共同开具纳洛酮处方的法律授权相关（发病率比 [IRR]，7.75；95%CI，1.22-49.35）。在其他所有变量保持不变的情况下，实施纳洛酮共同处方授权后，每月估计会额外开出 214 份纳洛酮处方。在协变量中，纳洛酮获取法（IRR，1.37；1.05-1.78）、阿片类药物过量死亡率（IRR，1.06；95%CI，1.04-1.08）、第三方支付者支付的纳洛酮处方比例（IRR，1.009；1.008-1.010）和时间（IRR，1.06；95%CI，1.05-1.07）与纳洛酮处方配药显著相关。
这些研究结果表明，对于有阿片类药物过量风险的患者，法律授权共同开具纳洛酮处方可能与纳洛酮配药的大幅增加以及阿片类药物相关伤害的进一步减少有关。
