Standing Order Naloxone Associated With Lower Opioid Fatality Rates

Community opioid fatality rates significantly decreased following standing order naloxone dispensing, relative to communities that did not implement pharmacy standing order naloxone. These study findings were recently research published in JAMA Network Open.

Previous research has demonstrated that access to naloxone is an effective strategy for reducing opioid fatalities. To improve access to naloxone, certain municipalities have introduced legislation that allows community pharmacies to dispense naloxone through a standing order.

To evaluate whether the implementation of pharmacy standing order naloxone was associated with a reduction in community opioid fatality rates, researchers conducted a retrospective cross-sectional study using data from 70% of retail pharmacies in Massachusetts. The researchers conducted a multisite interrupted time series analysis of opioid fatality rates across 351 municipalities between 2013 and 2018. The primary exposure of interest was the implementation of standing order naloxone dispensation. The primary outcome of interest was the opioid fatality rate per quarter at the municipal level, with opioid-related fatalities obtained from the Massachusetts Registry of Vital Records and Statistics.

The mean (SD) population size across all municipalities was 18,818 (39,368), 51.1% of whom were women and 29.2% were younger than 25 years of age. During the study period, 60.9% (n=214 municipalities) of pharmacies dispensed standing order naloxone.

The researchers found that implementation of standing order naloxone was associated with a higher quarterly opioid fatality rate (3.51 per 100,000 persons) than communities that did not have pharmacies with naloxone standing orders (1.03 per 100,00 persons; P <.001).

However, after adjusting for municipality-level sociodemographic and opioid prevention factors, the researchers observed no statistically significant change in opioid fatality rate was detected (adjusted rate ratio [aRR], 1.09; 95% CI, 0.99-1.20; P =.08) following the change to standing order naloxone dispensing. Further, implementation of standing order naloxone dispensing was associated with a significant slope decrease in opioid fatality rates (annualized aRR, 0.84; 95% CI, 0.78-0.91; P <.001), relative to communities that did not have naloxone standing orders. This slope corresponded to an annual relative decrease of 16.0% per 100,000 persons for opioid fatalities.

These findings were confirmed in sensitivity analyses.

Though no immediate level change in opioid fatalities was observed, findings from this study indicate that standing-order naloxone dispensing from community pharmacies is associated with a gradual and significant decrease in opioid fatality rates. The researchers concluded, “These findings of reduced opioid fatality rates associated with standing-order naloxone dispensing support the expansion of community naloxone access, including over-the-counter naloxone, as part of a multifaceted approach to address opioid overdose.”

The primary study limitations include the potential for residual confounding and the lack of assessment of over-the-counter naloxone.

This article originally appeared on Psychiatry Advisor