(111) Disparities in Naloxone Prescriptions During the COVID-19 Pandemic

Introduction: Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States (US) from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. We sought to assess and compare the naloxone prescribing rate at a tertiary medical center in 2019 and 2020, as it pertained specifically to patients diagnosed with opioid use disorder (OUD).

Methods: A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020 at the University of Alabama at Birmingham Hospital, inclusive of outpatient, inpatient and emergency department settings. Naloxone prescribing, defined as either a written prescription or a provided take home kit in the current study, was assessed for all patients who presented to the hospital from January 2019 through December 2020. Patient demographic characteristics, marital and insurance status, were also obtained. Analyses were performed using descriptive statistics and Chi-square analysis.

Results: In 2019, 11,959 visits were made by 2,962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020. Six hundred nine naloxone prescriptions in 2019 (5.1%) and 619 in 2020 (5.3%) were provided to these patients. In both years, most OUD-related visits were from whites (n=4,253, 75.9%), unmarried individuals (n=4,102, 73.2%), and males (n=2,870, 51.2%). Similarly, in both years most naloxone prescriptions were given to whites (n=934, 76.1%), unmarried individuals (n=920, 74.9%), and males (n=651, 53.0%), with no significant differences between 2019 and 2020. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (202 vs 274, 33.2% vs 44.3%, p< 0.05). Compared with 2019, more patients were admitted to inpatient settings due to OUD (770 vs 824, 26.0% vs 31.2%, p< 0.05) and received more naloxone prescriptions in the inpatient setting (282 vs 384, 46.3% vs 62.0%, p< 0.05) in 2020. In addition, compared to 2019, the percentage of multiple presentations to the ED (p <.001) and inpatients (p=.02) settings increased in 2020.

Conclusion: In general, naloxone prescribing rates are extremely low as compared to the number of visits from patients with OUD. Although prescription numbers were similar in both years, more uninsured patients received naloxone prescriptions in 2020, especially in the inpatient setting. These findings may indicate the need for improving naloxone awareness in providers and prescribing for patients at risk for opioid overdose, particularly in emergency department and outpatient settings.

References: Czeisler MÉ, Marynak K, Clarke KE, et al. Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020. MMWR Morb Mortal Wkly Rep 2020;69:1250–1257. DOI: 10.15585/mmwr.mm6936a4
O’Donoghue AL, Biswas N, Dechen T, et al. Trends in Filled Naloxone Prescriptions Before and During the COVID-19 Pandemic in the United States. JAMA Health Forum. 2021;2(5):e210393. doi:10.1001/jamahealthforum.2021.0393
Ong AR, Lee S, Bonar EE. Understanding disparities in access to naloxone among people who inject drugs in Southeast Michigan using respondent driven sampling. Drug Alcohol Depend. 2020 Jan 1;206:107743. doi: 10.1016/j.drugalcdep.2019.107743. Epub 2019 Nov 20. PMID: 31801107.