Should Doctors Co-Prescribe Naloxone With Opioids?

The opioid epidemic has been splashed across major newspapers and television networks. The U.S. Department of Health and Human Services warns that 44 people die each day because of opioid overdose. Thousands more across the country are affected by the opioid epidemic in other ways. Now, the American Medical Association has presented a possible solution to the epidemic: co-prescribing naloxone with opioid medications. Evaluating this solution is important for public health officials to make informed choices about opioid medications.

Should Doctors Co-Prescribe Naloxone With Opioids?

Should Doctors Co-Prescribe Naloxone with Opioids?

The American Medical Association Presents a Possible Solution to the Opioid Epidemic

Millions of people have used prescription opioid drugs to manage pain. When these medications first appeared on the market, they transformed the lives of many people struggling with acute or chronic pain. However, prescription opioid painkillers also have a dark side. These drugs cross the blood-brain barrier, changing neural circuitry that controls the brain’s reward pathways. This causes some people who use prescription opioids to develop opioid addiction.

Opioid addiction has reached epidemic proportions in the United States. From 2000 to 2014, nearly 500,000 people died from opioid overdose, reports the Centers for Disease Control and Prevention.

One common response to this epidemic has been calls for physicians to adopt stricter guidelines to prevent overprescribing of opioids. Many physician advocacy groups believe that this will restrict doctors’ autonomy in practicing medicine. In response to the opioid crisis, the American Medical Association has suggested that doctors should co-prescribe naloxone (an opioid antagonist) to certain patients being prescribed opioid painkillers. The AMA believes that this could combat the high overdose rate among opioid users.

Benefits of Co-Prescribing Naloxone and Opioid Painkillers

Naloxone is a drug that can reverse opioid overdose while it is happening. During an overdose, the opioids cause the central nervous system to become severely depressed. This leads to reduced cardiorespiratory activity that can eventually be fatal. Naloxone binds even more tightly to the brain’s opioid receptors than do opioid painkillers. However, it does not have the same central nervous system depressing effects as prescription opioids.

Thus, using naloxone in an overdose situation can help the person begin breathing again. Advocates of co-prescribing naloxone and opioid painkillers argue that it will decrease the number of people who die from opioid-related overdoses. Many states have passed laws to increase access to naloxone and to prevent “good Samaritans” from helping people undergoing overdose from facing legal action. The AMA believes that co-prescribing naloxone with opioid painkillers can get this lifesaving drug into the hands of the people who need it most.

Disadvantages of Co-Prescribing Naloxone and Opioid Painkillers

There is no inherent problem with prescribing naloxone. The drug is safe, effective, and can be used to prevent overdose. However, focusing on co-prescribing naloxone with opioid painkillers gives the illusion of progress being made on combating the opioid epidemic without actually doing anything to help.

No matter how helpful in an overdose situation, naloxone does not prevent people from developing opioid addiction or dependence. Simply passing out another drug with each bottle of pain pills fails to address the real underlying problems: overprescribing of painkillers by physicians, a geopolitical situation that has rapidly increased opioid access, and a failure to invest in treatment resources that truly help.

This last point, the lack of treatment options for people struggling with opioid addiction or dependence, is one that is within our ability to address. Most people begin using opioids because of chronic pain or because they have a deep psychological or emotional pain to address. Our mental health system is failing patients, leaving them to cope with trauma, depression, anxiety, and serious mental illness on their own. As a result, patients turn to drugs such as opioid painkillers to dull the pain.

Prescribing naloxone will not even begin to touch this facet of the opioid epidemic. Giving naloxone to people in intense physical, psychological, or emotional pain will not help them overcome the true problems that are driving opioid addiction. Instead, we need a concerted effort from lawmakers and public health officials to create solutions that put patients first.

What do you think? Should doctors co-prescribe naloxone with opioids? Or do we need other solutions to the opioid epidemic?

Sources
About the Epidemic, HHS. Retrieved on 06/21/2016.
Understanding the Epidemic, CDC. Retrieved on 06/21/2016.