An Observational Study of Retail Pharmacy Naloxone Prescriptions: Differences Across Provider Specialties and Patient Populations
Despite exponential growth in pharmacy-dispensed naloxone, little information is available regarding variation in naloxone prescribing pattern across specialty groups, regions, and patient populations.
Explore variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics.
Cross-sectional analysis of the 2016 national retail pharmacy naloxone prescription claims from the IQVIA Real Longitudinal Prescriptions database.
Naloxone prescribers and individuals filling naloxone prescriptions.
Descriptive statistics assess differences across prescriber specialty groups in number of naloxone prescribers, patient and prescription characteristics, and geographic variation in naloxone dispensation and naloxone market share across prescriber specialty groups or formulation.
In 2016, 100,958 naloxone prescriptions written by 14,026 prescribers were filled by 88,735 patients. Primary care physicians accounted for the largest share of naloxone prescribers (45.9%); pain and anesthesia physicians and non-physicians prescribed to significantly greater numbers of patients (means of 10 and 8, respectively). While responsible for a relatively small share of naloxone dispensed (6.1%), psychiatrists and addiction specialists disproportionately served younger individuals, accounting for 49.5% of all prescriptions for individuals aged 35 and younger. Naloxone fill rates differed greatly across geographic regions, with the highest per capita rates in New England and the most concentrated prescribing in the West South Central and South Atlantic regions, where naloxone prescribers had the highest average numbers of patients (9.7 and 7.9, respectively). The South Atlantic and West South Central also had naloxone markets dominated by the Evzio® auto-injector, responsible for 50.3% and 43.8% of all naloxone dispensed in the regions; in contrast, New England’s naloxone market was predominantly comprised of generic formulations (48.8%) and Narcan® nasal spray (45.4%).
Our findings reflect a need to better understand barriers to uptake of naloxone prescribing behavior among physicians and other prescribers to ensure individuals have adequate opportunity to receive naloxone from their treating clinicians.
KEY WORDSnaloxone prescribing patterns pharmacy
The authors would like to thank Hilary Peterson for assistance in manuscript preparation.
This work was supported by the National Institute on Drug Abuse (NIDA) through R21 DA045950 (Smart, PI) and P50 DA046351 (Stein, PI).
Compliance with Ethical Standards
The corresponding author’s Institutional Review Board approved the study.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 1.Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR. 2019;67(5152):1419.Google Scholar
- 12.Statement from FDA Commissioner Scott Gottlieb, M.D. on unprecedented new efforts to support development of over-the-counter naloxone to help reduce opioid overdose deaths [press release]. Silver Spring, MD: U.S. Food and Drug Administration; 2019.Google Scholar
- 13.Centers for Disease Control and Prevention. Rising numbers of deaths involving fentanyl and fentanyl analogs, including carfentanil, and increased usage and mixing with non-opioids; 2018. Available at: https://emergency.cdc.gov/han/han00413.asp. Accessed August 15, 2019.
- 14.Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. American Public Health Association; 2018.Google Scholar
- 18.Center for Behavioral Health Statistics and Quality. 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville: Substance Abuse and Mental Health Services Administration; 2018.Google Scholar
- 28.Association of American Medical Colleges. Active physicians by age and specialty, 2015; 2016. Available at: https://www.aamc.org/data/workforce/reports/458494/1-4-chart.html. Accessed August 15, 2019.
- 29.Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999-2017. Hyattsville: National Center for Health Statistics; 2018.Google Scholar
- 30.Multiple Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018 [Internet]. National Center for Health Statistics; 2018. Available at: http://wonder.cdc.gov/mcd-icd10.html. Accessed January 29, 2019.
- 31.Centers for Disease Control and Prevention. Drug overdose deaths. 2018. Available at: https://www.cdc.gov/drugoverdose/data/statedeaths.html. Accessed August 15, 2019.