Naloxone was under-prescribed to eligible adult patients with chronic opioid use, according to findings presented at AMCP 2022.

“Coprescribing of naloxone among specific patients with chronic opioid use is encouraged to reduce rates of opioid related deaths and emergency room visits,” researchers wrote. “Additional data are needed to evaluate how medications are prescribed in this population.”

The retrospective cross-sectional analysis included 4568 patients split into 2 cohorts: those with an average daily morphine milligram equivalent (MME) dose <50, and those with an MME dose ≥50. Between each cohort, authors compared the prescribing patterns of benzodiazepines, skeletal muscle relaxants, hypnotics, GABA analogs, selective-serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, antipsychotics, and naloxone.

Most patients in the sample (n=3452) were assigned to the daily MME <50 cohort. The daily MME ≥50 cohort (n=1116) was more likely to be prescribed the following:

• skeletal muscle relaxants (OR: 1.43, 95% CI: 1.22-1.68);
• hypnotics (OR: 1.74, 95% CI: 1.45-2.09);
• selective-norepinephrine reuptake inhibitors (OR: 1.35, 95% CI: 1.14-1.59);
• tricyclic antidepressants (OR: 1.61, 95% CI: 1.25-2.07); and
• naloxone (OR: 2.97, 95% CI: 1.36-3.73).

Additionally, patients had 2.58-4.04 (P ≤ .004) times the odds of being prescribed a daily MME ≥50 if they were over 85 years of age.

“Nearly one-fourth of patients were prescribed a daily MME ≥ 50. These patients were more likely to use tricyclic antidepressants, skeletal muscle relaxants, or hypnotics, which have been associated with adverse events among adults at risk for opioid overdose,” authors noted.

Naloxone was prescribed to only 11% of eligible patients, data showed.

“Implementation of targeted services should be considered to assess prescribing among patients with chronic opioid therapies,” researchers concluded.

Reference:
Silva Almodovar A, Nahata M. Prescribing patterns for high chronic opioid doses and concurrent medications: associations between patient characteristics and opioid prescribing in Medicare adults. Poster presented at: AMCP 2022; March 29-April 1, 2022; Chicago, IL.