A month after the Surgeon General issued an advisory calling for more people to carry naloxone, a Health Affairs blog post underscored the complexity of identifying who is most likely to benefit, as well as ensuring accessibility and affordability.
Last month, Surgeon General Jerome M. Adams, MD, issued an advisory calling for more people to carry naloxone to counteract opioid overdoses, highlighting the seriousness of the epidemic. However, the national implementation of a policy that would enhance access to naloxone faces a variety of barriers, according to a Health Affairs blog post.
The blog post, co-authored by A. Mark Fendrick, director of the Center for Value-Based Insurance Design at the University of Michigan and co-editor-in-chief of The American Journal of Managed Care®, underscored the complexity of identifying who is most likely to benefit, as well as ensuring accessibility and affordability.
The authors identified 3 groups who require distribution approaches tailored to their specific needs: prescription opioid users, illegal opioid users, and third-party witnesses of overdose.
For prescription opioid users, patients can be stratified based on their “risk score,” which takes into account substance use disorders, mental health comorbidities, high prescribed dosages, and concurrent use of benzodiazepines or antidepressants.
“Since these patients interact regularly with the healthcare system, electronic medical records could be used to identify at-risk individuals,” write the authors. “Clinical support tools could then alert clinicians to prescribe naloxone concomitantly with other medical prescriptions to allow more convenient access for the patient.”
As an estimated 13% to 69% of illegal opioid users will experience an overdose, the authors recommend universal naloxone distribution to this patient population. However, the challenge lies in identifying who these users are and ensuring access and affordability. The authors noted that due to the stigma of asking a pharmacist for naloxone, thoughtful processes to reduce the stigma are needed in order to improve distribution.
Law enforcement officers and first responders, as well as caregivers, family, and friends who regularly interact with high-risk individuals, can play a role in reducing fatal overdoses with access to and administration of naloxone. The authors recommend site training and distribution of naloxone in areas with high rates of opioid use disorders.
The other component of ensuring access to naloxone is affordability. “Even if high-risk individuals and bystanders are appropriately identified, supplying this potentially lifesaving medication may be impossible unless it is easily affordable,” write the authors. They highlight that the reduction or elimination of consumer cost sharing to enhance distribution will require collaboration from all sectors—health sciences companies, pharmaceutical benefit managers, and health plans.
They also note that, even with a reduction in consumer cost sharing, those enrolled in high-deductible health plans are required to pay the full price of the drug until they reach their deductible. Currently, there are 2 bipartisan bills that would allow predeductible coverage for naloxone.
“Expanding access to naloxone is by no means a sufficient solution for the opioid epidemic,” recognize the authors. They conclude: “However, a broad consensus of stakeholders support the Surgeon General’s advisory to expand access to naloxone to reduce opioid overdose-related deaths. This short-term strategy is necessary while more robust systems are implemented to allow more patients into long-term treatment.”
Lagisetty P, Bohnert A, Fendrick AM. Meeting the opioid challenge: getting naloxone to those who need it most. Health Affairs blog. May 11, 2018. healthaffairs.org/do/10.1377/hblog20180510.164285/full. Accessed May 11, 2018.