Legal Requirements and Recommendations to Prescribe Naloxone
Published in: Drug and Alcohol Dependence, Volume 209 (April 2020). doi: 10.1016/j.drugalcdep.2020.107896
Posted on RAND.org on February 21, 2020
Download Support Files
OPTIC-Vetted Naloxone Policy Data
|zip file||0.1 MB||
The file(s) provided above are ZIP-formatted archives, which most modern systems can natively unpack. If your computer does not unpack the archive when you double-click it, you may need to use a separate decompression program such as UnZip.
Read MoreAccess further information on this document at Drug and Alcohol Dependence
This article was published outside of RAND. The full text of the article can be found at the link above.
The continued toll of opioid-related overdoses has motivated efforts to expand availability of naloxone to persons at high risk of overdose, with 2016 federal guidance encouraging clinicians to co-prescribe naloxone to patients with increased overdose risk. Some states have pursued analogous or stricter legal requirements that could more heavily influence prescriber behavior.
We conducted a systematic legal review of state laws that mandate or recommend that healthcare providers prescribe naloxone to patients with indicators for opioid overdose risk. We coded relevant statutes and regulations for: applicable populations, patient criteria, educational requirements, and exemptions.
As of September 2019, 17 states had enacted naloxone co-prescribing laws, the earliest of which was implemented by Louisiana in January 2016. If patient overdose risk criteria are met, over half of these states mandate that providers prescribe naloxone (7 states, 41.1%) or offer a naloxone prescription (2 states, 11.8%); the remainder encourage prescribers to consider prescribing naloxone (8 states). Most states (58.8%) define patient overdose risk based on opioid dosages prescribed, although the threshold varies substantially; other common overdose risk criteria include concomitant opioid and benzodiazepine prescriptions and patient history of substance use disorder or mental illness.
A growing minority of states has adopted a naloxone prescribing law, although these policies remain less prevalent than other naloxone access laws. By targeting higher-risk patients during clinical encounters, naloxone prescribing requirements could increase naloxone prescribed, destigmatize naloxone use, and reduce overdose harms. Further investigation into policy effectiveness, unintended consequences, and appropriate parameters is warranted.
Supplementary data created in the course of this research is available for download above.