AMA Recommendation on Naloxone Co-Prescribing
Opioid overdoses may be reduced by co-prescribing naloxone with opioids.
Co-prescribing naloxone with opioids may reduce opioid overdoses while playing a pivotal role in combating the nation's opioid addiction epidemic, according to a statement issued by the American Medical Association (AMA) Opioid Task Force.1
When clinically appropriate and feasible, the AMA Opioid Task Force recommends the co-prescribing of naloxone — a US Food and Drug Administration (FDA)-approved medication used to reverse the effects of opioids — as a precaution against opioid overdose in patients taking these medications for chronic pain. In effect, this action may also prevent overdoses in patients who are addicted to opioids and patients who misuse or abuse these medications for euphoric purposes.
According to the Task Force's recommendations, several factors come into play when deciding to prescribe naloxone along with opioids. For example, a physician may need to assess the patient's history to determine if he/she has a pattern of high opioid usage. If so, prescribing naloxone may be appropriate. In addition, in cases in which the patient has a concomitant benzodiazepine prescription, an underlying mental health condition, or a medical condition that may increase opioid toxicity, it is recommended that physicians consider co-prescribing naloxone.
One issue with co-prescribing naloxone is the initiation of a conversation surrounding the potential for overdose or opioid toxicity. Patients may take offense or experience stigma surrounding opioid overdose, which may make communication of the issue challenging. Physicians are urged to discuss treatment for substance use disorder in broad terms to ensure that the patient is comfortable with the prescription and does not feel marginalized or harassed.
In addition to prescribing naloxone, it is also recommended that physicians educate their patients and/or their patients' family members regarding the steps to take in case of a potential overdose. According to the Task Force, the act of “co-prescribing naloxone has been found to reduce emergency department visits and may help patients become more aware of the potential hazards of opioid misuse.”
Help save lives: Co-prescribe naloxone to patients at risk of overdose. AMA Opioid Task Force. American Academy of Family Physicians. Accessed September 27, 2017.