RAND Corporation, Boston, MA, United States; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States; Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.
RAND Corporation, Santa Monica, CA, United States.
Drug Alcohol Depend. 2020 Apr 1;209:107896. doi: 10.1016/j.drugalcdep.2020.107896. Epub 2020 Feb 6.
The continued toll of opioid-related overdoses has motivated efforts to expand availability of naloxone to persons at high risk of overdose, with 2016 federal guidance encouraging clinicians to co-prescribe naloxone to patients with increased overdose risk. Some states have pursued analogous or stricter legal requirements that could more heavily influence prescriber behavior.
We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk. We coded relevant statutes and regulations for: applicable populations, patient criteria, educational requirements, and exemptions.
As of September 2019, 17 states had enacted naloxone co-prescribing laws, the earliest of which was implemented by Louisiana in January 2016. If patient overdose risk criteria are met, over half of these states mandate that providers prescribe naloxone (7 states, 41.1 %) or offer a naloxone prescription (2 states, 11.8 %); the remainder encourage prescribers to consider prescribing naloxone (8 states). Most states (58.8 %) define patient overdose risk based on opioid dosages prescribed, although the threshold varies substantially; other common overdose risk criteria include concomitant opioid and benzodiazepine prescriptions and patient history of substance use disorder or mental illness.
A growing minority of states has adopted a naloxone prescribing law, although these policies remain less prevalent than other naloxone access laws. By targeting higher-risk patients during clinical encounters, naloxone prescribing requirements could increase naloxone prescribed, destigmatize naloxone use, and reduce overdose harms. Further investigation into policy effectiveness, unintended consequences, and appropriate parameters is warranted.
阿片类药物相关过量用药的持续影响促使人们努力扩大纳洛酮的供应，以提供给有过量用药风险的人群。2016 年联邦指南鼓励临床医生为有增加的过量风险的患者共同开纳洛酮处方。一些州也采取了类似或更严格的法律要求，这可能会更重地影响医生的行为。
我们对要求或建议医疗保健提供者为有阿片类药物过量风险指标的患者开纳洛酮处方的州法律进行了系统的法律审查。我们为相关法规和条例编码了：适用人群、患者标准、教育要求和豁免。
截至 2019 年 9 月，17 个州已经颁布了纳洛酮共同处方法律，最早的是路易斯安那州于 2016 年 1 月实施的。如果患者的过量风险标准得到满足，超过一半的州要求提供者开纳洛酮处方（7 个州，41.1%）或提供纳洛酮处方（2 个州，11.8%）；其余的州鼓励医生考虑开纳洛酮处方（8 个州）。大多数州（58.8%）根据开处的阿片类药物剂量来定义患者的过量风险，尽管阈值有很大差异；其他常见的过量风险标准包括同时开处阿片类药物和苯二氮䓬类药物以及患者有物质使用障碍或精神疾病的病史。
越来越多的州通过了纳洛酮处方法律，尽管这些政策仍然比其他纳洛酮获取法律更为少见。通过在临床接触期间针对高风险患者，纳洛酮处方要求可以增加纳洛酮的处方量，消除纳洛酮使用的污名化，并减少过量用药的危害。需要进一步调查政策的有效性、意外后果和适当的参数。
