Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States
Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States
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DOI：
10.1001/jamanetworkopen.2019.6215
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发表时间：
2019-06-01
影响因子：
13.8
通讯作者：
Freeman, Patricia R.
中科院分区：
文献类型：
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作者：
Sohn, Minji;Talbert, Jeffery C.;Freeman, Patricia R.
为了缓解阿片类药物过量危机，各州实施了各种法律的干预措施，旨在增加阿片类药物拮抗剂纳洛酮的使用。最近，弗吉尼亚州和佛蒙特州授权的coprescription纳洛酮为潜在的风险patients. ObjectiveTo评估之间的关联纳洛酮coprescription法律的任务和纳洛酮配药在零售pharmacs.DESIGN，设置，和参与者这是一个人口为基础的，国家级的队列研究。样本包括IQVIA国家处方审核中包含的零售药店中的所有纳洛酮处方，该处方代表了美国所有零售药店的90%。观察单位为州月，研究期为2011年1月1日至2017年12月31日。暴露国家法律的干预强制纳洛酮coprescription.Main结果和措施的数量纳洛酮处方分发。结果实施纳洛酮处方法律的强制后，纳洛酮处方的使用率有所上升。在法律的要求有效的第一个完整月内，弗吉尼亚州每10万人中估计有88张纳洛酮处方，佛蒙特州每10万人中估计有111张处方。相比之下，在阿片类药物过量死亡率最高的10个州（包括哥伦比亚特区），每10万人中有16张纳洛酮处方，在其余39个州，每10万人中有6张处方。纳洛酮处方数量与纳洛酮共处方的法律的授权相关（发生率比[IRR]，7.75; 95% CI，1.22-49.35）。纳洛酮处方授权的实施与在授权后的一段时间内每月分发的估计214份额外的纳洛酮处方有关，所有其他变量保持不变。在协变量中，纳洛酮使用规律（IRR，1.37; 1.05-1.78），阿片类药物过量死亡率（IRR，1.06; 95% CI，1.04-1.08），第三方支付者支付的纳洛酮处方百分比（内部收益率1.009; 1.008-1.010）和时间（内部收益率，1.06; 95%可信区间，（1.05-1.07）结论和相关性这些研究结果表明，法律规定的阿片类药物过量风险的纳洛酮处方可能与阿片类药物过量的实质性相关。增加纳洛酮分配和进一步减少阿片类药物相关的危害。
IMPORTANCE To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients.OBJECTIVE To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies.DESIGN, SETTING, AND PARTICIPANTS This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA's national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month and the study period was January 1, 2011, to December 31, 2017. EXPOSURES State legal intervention mandating naloxone coprescription.MAIN OUTCOMES AND MEASURES Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated.RESULTS The rate of naloxone dispensing increased after implementation of legal mandates for naloxone coprescription. An estimated 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 the legal requirement was effective. In comparison, 16 naloxone prescriptions per 100 000 were dispensed in the 10 states (including the District of Columbia) with the highest opioid overdose death rates and 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). Implementation of the naloxone coprescription mandate was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates, holding all other variables constant. Among covariates, 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) were significantly associated with naloxone prescription dispensing.CONCLUSIONS AND RELEVANCE 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.