It's about saving lives: Increasing access to naloxone

Patrice A. Harris, MD, MA , Former President

As our nation suffers from a prescription opioid and heroin overdose epidemic, the U.S. Food and Drug Administration (FDA) is holding a public hearing this week to explore the uptake and use of naloxone, a lifesaving medication that can reverse opioid overdoses.

More than 16,000 deaths in 2013 involved prescription opioids, and another 8,000 involved heroin. America’s physicians must do a better job of using all available tools to help stop this epidemic. Among the powerful tools in our arsenal that we must regularly use are prescription drug monitoring programs, enhanced education and naloxone.

From 1996 to 2014, community-based organizations reported more than 26,000 overdose reversals based on the use of to this medication, according to the Centers for Disease Control and Prevention.

The AMA and many community, state and national groups—including professional organizations, government bodies and industry organizations—have supported co-prescribing naloxone to patients who are taking opioids as a critical part of the solution to the rising epidemic of opioid-overdose related deaths.

Co-prescribing naloxone likely will be a part of the FDA hearing this week and will be a part of the AMA’s testimony at this event. The AMA encourages physicians to co-prescribe naloxone to their patients at-risk who are taking opioid analgesics.

I recently had the honor of testifying (log in) before the U.S. House of Representatives Energy and Commerce Oversight and Investigations Subcommittee in support of new state laws to put naloxone into the hands of appropriately trained first responders and friends and family members who may be in a position to help save lives.

The AMA also has supported nearly 20 such new state laws in the past two years and emphasized the importance of these laws to many key stakeholders, including the National Governors Association (log in to read a recent letter we sent).

What we need now is to ensure all physicians have the information and education they need to fully understand the barriers to access and the benefits of naloxone. An AMA issue brief (log in) provides additional information about this medication.

Recent activities that have paved the way for more effective use of naloxone include:

  • A Kaiser Permanente study, which recommends a universal prescribing method, in which naloxone would be indicated for all patients prescribed chronic opioids. The study revealed a need for increased awareness and dialogue surrounding the prescription of naloxone in conjunction with opioids. Clinicians who were surveyed were reluctant to prescribe naloxone because they did not want to offend patients by talking to them about a risk of overdose and because there hasn’t been consensus over who should be prescribed the drug. 
  • Guidelines issued last month by the American Society of Addiction Medicine, which recommend the establishment of a co-prescription program for patients prescribed high-potency, long-acting opioids. 
  • FDA approval of the EVZIO® (naloxone HCl injection) auto-injector, which can be prescribed by physicians. We have commended the FDA for expediting the approval process to quickly increase access to this medicine, which undoubtedly will save lives by reducing death from opioid-related overdose. 
  • The Veterans Health Administration’s Overdose Education and Naloxone Distribution program for all veterans in treatment for a substance use disorder or taking opioids chronically. 
  • Legislation in the Commonwealth of Virginia that requires risk mitigation guidelines on the prescription of extended-release and long-acting opioid analgesics to include co-prescription of naloxone for administration by family members or caregivers in a non-medically supervised environment.

Increased access to naloxone is a key element of a comprehensive public health approach to decrease prescription drug overdose. The AMA believes that co-prescription of naloxone and enhanced access to this medication in community-based programs—coupled with increased use of prescription drug monitoring programs and enhanced education and awareness about the number of opioid emergencies—are critical next steps in reversing the growing epidemic of opioid-related morbidity and mortality.