Chicago—New policies from the American Medical Association (AMA) call for “collaborative practice agreements” with pharmacists, as well as standing orders for pharmacies, where legal, to increase availability of naloxone to reverse opioid overdoses.

The policies were adopted recently at the AMA’s annual meeting. Physicians are urged to co-prescribe naloxone to patients at risk of an overdose; promote timely and appropriate access to nonopioid and nonpharmacologic treatments for pain; and support efforts to delink payments to healthcare facilities with patient satisfaction scores relating to the evaluation and management of pain.

“The AMA and our nation's physicians have demonstrated our commitment to ending this epidemic,” said Patrice A. Harris, MD, chair-elect of the AMA and chair of the AMA Task Force to Reduce Opioid Abuse. “These new policies build on the work of our task force, which has made clear that physicians must take a leading role in reversing the tide of this epidemic.”  

In an effort to increase access to naloxone for friends and family members of patients at risk of overdose, the policy also:

• encourages private and public payers to include all forms of naloxone on their preferred drug lists and formularies with nominal or no cost sharing;
• supports liability protections for physicians and other authorized health care professionals to prescribe, dispense and administer naloxone;
• calls for more legislation to enable law enforcement agencies to carry and administer naloxone, as many states have done.

“These policies will save lives. That’s the bottom line,” Harris said. “Time and time again, we have seen naloxone save lives once it is in the hands of first responders. We just have to make sure that we are co-prescribing it when clinically indicated, and that it is affordable for the community and available at local pharmacies.”   

A study published recently in Annals of Internal Medicine supports the view that naloxone can be successfully co-prescribed to patients receiving opioid analgesics for chronic pain in primary care.

San Francisco Department of Public Health–led researchers found that naloxone co-prescribing was associated with reduced opioid-related emergency department visits. Study authors suggest that adopting the practice could reduce opioid-related adverse events.

After developing a standardized naloxone co-prescribing program (Naloxone for Opioid Safety Evaluation) at primary care clinics in a safety net system in San Francisco, researchers assessed the feasibility of introducing and scaling up naloxone co-prescribing and analyzed the association of naloxone co-prescribing with ED utilization.

Results indicate that, compared to patients not prescribed naloxone, patients prescribed naloxone had substantially fewer opioid-related emergency room visits even when there was no net change in opioid dose.

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