FDA May Recommend Naloxone Be Co-Prescribed With Opioids

By Kelly Burch 02/22/19

The "co-prescribing" recommendation would apply to patients who are at high risk of overdose, including people who take a high-dose opioid.

doctor writing a prescription for naloxone and prescription opioids

The Food and Drug Administration (FDA) is considering recommending that people who receive an opioid prescription are also offered a prescription for naloxone, the opioid overdose reversal drug. 

The move is intended to reduce deaths from opioid overdose, but some people say that the effort is misguided. 

The so-called co-prescribing recommendation would apply to patients who are at high risk of overdose, including people who take a high-dose opioid, have a history of addiction or have sleep apnea, according to CNN.

Kristy Shepard, a Virginia patient who uses opioids, didn’t know that she had a naloxone prescription waiting for her at the pharmacy. She said that her doctor didn’t give her a heads up about the state’s new co-prescribing recommendations. Other states, including California and Ohio have made similar recommendations, but Shepard doesn’t understand why. 

"It's so silly. I didn't feel like I needed it. Unless I plan to hurt myself, I'm not likely to overdose," she said. 

However, Dr. Nathan Schlicher, who is on Washington state’s opioid task force and works as an emergency medicine physician, said this is a common misunderstanding. 

"You can take pain meds responsibly, and you can be at risk for an accidental overdose even when you're doing everything right,” he said. Washington also has a co-prescribing recommendation. 

If the FDA recommends co-prescribing, the need for naloxone would increase by 48 million dosages annually, according to an FDA report. That could be a big financial incentive to drug makers, who have spent money lobbying for similar efforts at the state level, especially in California. 

Some opponents point out that having naloxone on hand only works if the people taking opioids have someone around who could administer the drug if they overdose. 

Katie O’Leary, who deals with pain, said that talking about overdose risk and carrying naloxone should be a conversation between individual providers and their patients, not a federal requirement. 

"So many patients already jump through so many hoops to get their meds," she said. "And if you live alone and don't have family or friends to take care of you, the naloxone might not be something that could actually help." 

Dr. Farshad Ahadian, medical director at the University of California San Diego Health Center for Pain Medicine, agreed, saying, “Most providers probably feel that it's better for physicians to self-regulate rather than practice medicine from the seat of the legislature. The truth is there's been a lot of harm from opioids, a lot of addiction. It's undeniable that we have to yield to that and to recognize that public safety is critical."

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.