“You cannot recover if you are not alive.”

Clockwise from top left: Dr. Stephen Loyd, MD, FACP,Dr. Kevin Zacharoff, Assemblyman John Armato (D-NJ-2), and Shatterproof’s Courtney Hunter discuss co-prescribing an reversal agent to people at risk of an opioid overdose.

The opioid crisis has resulted in close to 600,000 deaths since 1999, however, evidence shows that increasing the availability of naloxone—a prescription medication that reverses the respiratory depression caused by an opioid overdose—reduces the rate of opioid overdose deaths.

Co-prescribing naloxone is supported by a broad range of stakeholders including the World Health Organization, U.S. health agencies (CDC, SAMHSA), state departments of health, the American Medical Association, and many patient, consumer and other advocacy groups.

States can enact policies that require or allow physicians and other prescribers to write individual naloxone prescriptions to patients who use opioids and to their friends and family.

A study of five states with required co-prescribing, including Virginia, found the dispensation of naloxone grew by 255 percent in the 90 days following implementation of the mandate compared with the 90 days prior.

Yet, despite recommendations to co-prescribe naloxone to patients at increased risk for opioid overdose, co-prescribing rates remain low overall.

In May, we assembled a panel of four experts to discuss this topic and best practices to combat the opioid crisis:

  • Dr. Stephen Loyd, MD, FACP, Former Medical Director for Substance Abuse Services for the State of Tennessee and Current National Medical Director of JourneyPure Addiction Clinic
  • Assemblyman John Armato (D-NJ-2), Primary Sponsor of A. 3969, New Jersey’s Naloxone Co-Prescription Legislation
  • Dr. Kevin Zacharoff, Clinical Professor of Preventative Medicine at Stonybrook University and author of The PainEDU.org Manual: A Pocket Guide to Pain Management and Managing Chronic Pain with Opioids in Primary Care
  • Courtney Hunter, Vice President for State Policy at Shatterproof.

The panel agreed that in order to save lives and reverse this troubling trend, we must improve education about addiction and overdose, eliminate stigma and rapidly advance co-prescribing. The following important notions and solutions, among many, were highlighted during the panel:

Education

  • Understand addiction as a chronic disease of the brain
    • Stephen Loyd: “People who are stuck in an addictive disease don’t understand it. The frontal lobe of your brain is not functioning properly and so you lose insight and judgment and empathy, and it doesn’t matter your level of training.”
  • Educate on the life-saving role of overdose reversal medicines like naloxone – and how it works
  • Reach all populations, especially those disproportionately affected by the opioid crisis and those most at risk
  • Enhance formal education for medical providers, students, pharmacists, etc.
    • Medical students – Build learnings about stigma and bias, pain and addiction and rescue medications into curricula
    • Providers – Teach healthcare providers that words matter. The way things are presented to people matters. Naloxone shouldn’t be punitive or prescribed with judgement, changing the way you talk about co-prescribing can have a lasting impact.
    • Standards of care – Chronic pain guidelines and licensure/standards of care
  • It can’t all rest with the medical community, ideally, we strike a balance between harmony of community level distribution and healthcare/provider and patient education

 

Stigma

  • Address and eliminate deep-seated societal-level bias on addiction and drug use, which goes hand in hand with increasing education – with COVID, “we’ve lost the front page.” The more we talk about the issue, the more we reduce stigma.
  • One way to reduce stigma is shift the conversation from patient level risk to household level risk and create the proper interventions.
    • Lockboxes
    • Support for formerly incarcerated people
  • Representative Armato shared a personal story about the role of household risk and the importance of talking about addiction and loss, reducing stigma.
  • Ultimately, the point is – save a life, talk about the details later.

Co-prescribing

  • An important and proven, life-saving legislative measure
  • Goal is to get naloxone into the hands of individuals that need it the most
  • While co-prescribing is part of the solution, we must ensure prescriptions are full-filled by advancing and improving the education of pharmacists.

 

To learn more, you can watch a full recording of the panel on YouTube.

The most ethical approach is always going to be to take care of the whole person. Whether it’s about saving a life or whether it’s about choosing the right medication. We each have a role to play.

Addiction is treatable, treatment works, and people recover.