With opioid prescribing, naloxone intervention can save lives

Despite growing public health concerns and focus on the issue, opioid therapy remains an important piece of the puzzle for many patients receiving treatment for chronic pain.

However, the inherent risks associated with opioid therapy are a major public safety issue plaguing today’s society, breaking families apart, and contributing to the more than 52,400 drug overdoses accounted for each year. In fact, opioid overdose has replaced motor vehicle collisions as the number one cause of death for adults ages 18 to 64.

{mosads}Opioid over-prescribing has been a problem for years, with more than 2 million Americans suffering from substance use disorders related to prescription opioid pain relievers, and a reported 12 million Americans misusing them. Thankfully, prescribing control measures are being put in place and many state governments are taking action to curb this dangerous trend. The number of opioid prescriptions has decreased in recent years, yet still, about 90 people die each day from a preventable, opioid-related overdose.

“Preventable” because in the event of an opioid-related overdose there is a medication that can prevent patients from dying if administered promptly: naloxone.

When developing a pain management plan, I not only assess all angles of a patient’s medical history, but also focus on the risks of opioids themselves. Responsible prescribing practices are key to balancing effective treatment with patient safety, but the reality is there is always a risk.

That’s why when prescribing opioids I also often write a prescription for naloxone, when appropriate. Naloxone is available in several formulations, but in today’s opioid landscape, where naloxone is may be administered in nonmedical settings by friends, family members or loved ones, the easier and faster someone is able to administer the medication, the better.

Therefore, I favor the simpler and safer needle-free formulations of naloxone that do not require any formal medical training to administer. The difference between life and death in an overdose emergency can be a matter of seconds.

The risks associated with opioid therapy are a vital safety issue that all medical professionals should address with their patients during pain management consultations. From the moment patients enter my office, I take on the responsibility of their safety and the safety of their family members and loved ones. With prescription opioids in the home, everyone is vulnerable to misuse and overdose.

Co-prescribing naloxone with an opioid medication can:

• Mitigate the risks associated with opioid use
• Further the conversation between doctors and patients regarding the inherent risks of opioid use
• Distribute more naloxone in areas hardest hit by the epidemic
• Help to reduce the stigma associated with substance use disorder and addiction
• Provide friends, family and loved ones with the ability to prevent an accidental overdose in the home resulting from prescription opioids

The number of opioid prescriptions may have decreased in the nation in recent years, but the strength of these opioids remains the same, especially when combined with other prescription medications, like benzodiazepines. Naloxone is one solution that can prevent your friend, neighbor, family member or loved one from an unintentional, untimely and tragic death.

Millions of people are opioid dependent — whether it’s legal prescriptions or illicit street drugs. Protocols must be in place to address the potential risks of prescription opioid misuse, and ensure broad naloxone access is part of this.

Therefore, states, counties and communities have a role to play in not only educating the medical community and public about the risks associated with opioid use, but also encouraging access to and awareness of naloxone. In fact, earlier this month, the Commission on Combating Drug Addiction and the Opioid Crisis issued a report recommending the President mandate co-prescribing naloxone in high-risk opioid treatments.

States like Virginia, Vermont and Texas have already implemented actions encouraging co-prescribing, a major step in the right direction. Even more, education about opioid misuse and naloxone intervention is paramount, and it starts in the physician’s office. Co-prescribing naloxone with opioids to high risk patients will surely initiate those conversations and help get this potentially life-saving medication in the hands of those who need it.

Preventing accidental overdoses resulting from prescription opioids requires a serious commitment from government stakeholders and the medical community to continue to push toward greater naloxone access and education. Co-prescribing naloxone is an effective way of achieving that goal and can change how patients, physicians and community members approach and perceive opioid medication, potential misuses and abuse.

Matthew D. Holland, M.D. is a Pain Management specialist at National Spine & Pain Centers in Charlottesville, VA, and Harrisonburg, VA, where naloxone co-prescribing laws have been successfully in effect since March. Dr. Holland is a diplomate of the American Board of Anesthesiology with subspecialty certification in pain management.