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An Observational Study of Retail Pharmacy Naloxone Prescriptions: Differences Across Provider Specialties and Patient Populations

  • Rosanna SmartEmail author
  • Caroline K. Geiger
  • Christopher M. Jones
  • Bradley D. Stein
Original Research

Abstract

Background

Despite exponential growth in pharmacy-dispensed naloxone, little information is available regarding variation in naloxone prescribing pattern across specialty groups, regions, and patient populations.

Objective

Explore variation in pharmacy-dispensed naloxone by prescriber specialty and patient characteristics.

Design

Cross-sectional analysis of the 2016 national retail pharmacy naloxone prescription claims from the IQVIA Real Longitudinal Prescriptions database.

Participants

Naloxone prescribers and individuals filling naloxone prescriptions.

Main Measures

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.

Key Results

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%).

Conclusions

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 WORDS

naloxone prescribing patterns pharmacy 

Notes

Acknowledgments

The authors would like to thank Hilary Peterson for assistance in manuscript preparation.

Funding Information

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.

Supplementary material

11606_2019_5448_MOESM1_ESM.docx (305 kb)
ESM 1 (DOC/X 305 kb)

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Rosanna Smart
    • 1
    Email author
  • Caroline K. Geiger
    • 2
  • Christopher M. Jones
    • 3
  • Bradley D. Stein
    • 1
    • 4
  1. 1.RAND CorporationSanta MonicaUSA
  2. 2.Harvard UniversityCambridgeUSA
  3. 3.Centers for Disease Control and PreventionAtlantaUSA
  4. 4.University of Pittsburgh School of MedicinePittsburghUSA

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