Individual and Community Factors Associated with Naloxone Co-prescribing Among Long-term Opioid Patients

A Retrospective Analysis

Published in: Journal of General Internal Medicine (2021). doi: 10.1007/s11606-020-06577-5

by Bradley D. Stein, Rosanna Smart, Christopher M. Jones, Yaou Flora Sheng, David Powell, Mark J. Sorbero

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Naloxone co-prescribing to individuals at increased opioid overdose risk is a key component of opioid overdose prevention efforts.


Examine naloxone co-prescribing in the general population and assess how co-prescribing varies by individual and community characteristics.


Retrospective cross-sectional study. We conducted a multivariable logistic regression of 2017–2018 de-identified pharmacy claims representing 90% of all prescriptions filled at retail pharmacies in 50 states and the District of Columbia.


Individuals with opioid analgesic treatment episodes > 90 days.

Main Measures

Outcome was co-prescribed naloxone. Predictor variables included insurance type, primary prescriber specialty, receipt of concomitant benzodiazepines, high-dose opioid episode, county urbanicity, fatal overdose rates, poverty rates, and primary care health professional shortage areas.

Key Results

Naloxone co-prescribing occurred in 2.3% of long-term opioid therapy episodes. Medicaid (aOR 1.87, 95%CI 1.84 to 1.90) and Medicare (aOR 1.48, 95%CI 1.46 to 1.51) episodes had higher odds of naloxone co-prescribing than commercial insurance episodes, while cash pay (aOR 0.77, 95%CI 0.74 to 0.80) and other insurance episodes (aOR 0.81, 95%CI 0.79 to 0.83) had lower odds. Odds of naloxone co-prescribing were higher among high-dose opioid episodes (aOR 3.19, 95%CI 3.15 to 3.23), when concomitant benzodiazepines were prescribed (aOR 1.12, 95%CI 1.10 to 1.14), and in counties with higher fatal overdose rates.


Co-prescription of naloxone represents a tangible clinical action that can be taken to help prevent opioid overdose deaths. However, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, we found that co-prescribing rates remain low overall. States, insurers, and health systems should consider implementing strategies to facilitate increased co-prescribing of naloxone to at-risk individuals.

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