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Legal Mandates for Naloxone Coprescriptions May Increase Dispensing at Pharmacies

June 27, 2019

Recent research published online in JAMA Network Open shows that naloxone prescription dispensing may be higher in pharmacies where legal mandates require naloxone coprescriptions for potential at-risk patients.  

“To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone,” explained lead study author Minji Sohn, PhD, of the College of Pharmacy at Ferris State University, and colleagues. “Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients. 

In order to understand the relationship between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies, Dr Sohn and colleagues conducted a population-based, state-level cohort study from January 1, 2011 through December 31, 2017. The research team examined prescriptions that were dispended for naloxone within retail pharmacies. The data was obtained from IQVIA’s national prescription audit, which represented roughly 90% of all retail pharmacies across the country.  

The findings of the study showed that the rate of naloxone dispensing rose after legal mandates for coprescriptions were implemented. The research team said they found that roughly 88 naloxone prescriptions per 100,000 were dispensed in Virginia, and 111 prescriptions per 100,000 were dispensed in Vermont during the first full month that the legal requirement was effective. Comparatively, they said they found that only 16 naloxone prescriptions per 100,000 were dispensed in 10 states that had the highest opioid overdose death rate, and only 6 prescriptions per 100,000 were dispensed in the 39 remaining states.  

“The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22-49.35),” Dr Sohn and colleagues explained.

Further findings show that there were an estimated 214 additional naloxone prescriptions dispensed per month in the period following the coprescription mandates.  

The researchers noted that the following covariates were associated with naloxone prescription dispensing:

  • naloxone access laws (IRR, 1.37; 1.05-1.78);
  • opioid overdose death rates (IRR, 1.06; 95% CI, 1.04-1.08);
  • the percentage of naloxone prescriptions paid by third-party payers (IRR 1.009; 1.008-1.010); and,
  • time (IRR, 1.06; 95% CI, 1.05-1.07). 

“These study findings suggest that legally mandated naloxone prescription for those at risk for opioid overdose may be associated with substantial increases in naloxone dispensing and further reduction in opioid-related harm,” the research team concluded. 

Julie Gould  


Sohn M, Talbert JC, Huang Z, et al. Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States [published online June 21, 2019]. JAMA Netw Open. 2019;2(6):e196215. doi:10.1001/jamanetworkopen.2019.6215

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