Overdose antidote should accompany pain prescriptions, S.F. report urges
A drug that is effective at reversing heroin overdoses isn’t just for street addicts — it should be routinely distributed to people taking prescription pain medications who may not appreciate their risk of accidental death, San Francisco public health officials said in a study released Monday.
Doctors should consider regularly prescribing naloxone — a drug given by injection or nasal spray to counteract opioid overdoses — alongside narcotic pain medications, the study’s authors said.
Naloxone, often sold under the brand name Narcan, has become increasingly popular as a way to reverse heroin overdoses among street users. In San Francisco, naloxone has been widely distributed for more than 15 years to users and their friends and relatives, a practice that has dramatically cut heroin overdose
deaths — from 120 in 2000 to 30 in 2014.
But naloxone isn’t widely distributed to the larger population of prescription drug users, who now make up more than 75 percent of all overdose deaths in San Francisco.
Opioid overdoses, most of them involving prescription drugs, killed a record 28,000 people in the United States in 2014. High-profile deaths, like that of Prince this year, have underscored the need both to prevent addiction and to quickly treat people who have overdosed.
“This study really does show that naloxone has a substantial role to play in managing the opioid epidemic,” said Dr. Phillip Coffin, director of substance use research at the San Francisco Department of Public Health and lead author of the paper, published in the Annals of Internal Medicine. “It’s not the answer to all our problems, but it’s an important tool to prevent mortality.”
People on narcotic pain medications who have previously been addicted to drugs or alcohol, or who have overdosed before, are especially at risk and should always be offered naloxone, Coffin and other pain experts say. But even people who wouldn’t consider themselves at risk could probably benefit from having naloxone around in case of accidental overdose, Coffin said.
Deadly glass of wine
Some people may not realize, for example, that just one glass of wine on top of their Vicodin could cause an overdose, or that a new prescription for a sleep aid or muscle relaxant could create a deadly cocktail.
Symptoms of overdose include stopped or slowed breathing and loss of consciousness. Naloxone will usually revive someone after one or two minutes, though some people may need a second dose. Anyone who is treated for overdose should be seen by a doctor right away.
Coffin’s research involved six San Francisco public health clinics, where doctors and other care providers were offered training for prescribing naloxone to patients taking opioid pain medications. From February 2013 to April 2014, 759 patients — a little over a third of all people prescribed opioids at those clinics — were given naloxone prescriptions.
ER visits dropped
The study found that over the following year, patients with naloxone prescriptions had about 50 percent fewer visits to an emergency room for opioid-related problems — including overdoses, falls or requests for more pain medications — compared with those who didn’t get a prescription. The study did not look at overdose deaths because there weren’t enough people involved to draw statistically significant conclusions.
Some health care providers have wondered whether prescribing naloxone could lead to an increased use of opioids, but the San Francisco researchers found no evidence of it. Instead, Coffin and other pain and addiction experts believe that prescribing an overdose antidote may make patients more inclined to be cautious about their opioid use.
“If I’m telling you this medication is dangerous and I’m also prescribing you the antidote to this medication — that’s stark information,” Coffin said. “It makes the messaging stick.”
No prescription needed
The U.S. Centers for Disease Control and Prevention recommends that doctors consider naloxone prescriptions for some patients using opioids — mostly those considered to be at high risk of overdosing. Naloxone is also available without prescription from pharmacies in California and several other states.
Kaiser Permanente encourages its doctors to prescribe it to patients who are on prolonged, high-dose pain management regimens. Patients can also pick up naloxone at a Kaiser pharmacy without their doctor knowing they’ve asked for it.
Sutter Health, too, has been pushing out more naloxone prescriptions on patients with a history of opioid abuse, said Dr. Josh Kayman, medical director of Sutter’s adult substance abuse inpatient program in Oakland.
At New Leaf Treatment Center in Lafayette, staffers began handing out naloxone to clients as well as friends and family late last year because of the frequency of overdoses among opioid users, said Dr. Alex Stalcup, medical director. They’ve distributed hundreds of naloxone kits, Stalcup said, and so far they know of six people who took it after overdosing.
“People are happy to have it,” Stalcup said. “They know they’re dancing on a dime, and it’s really good to know — here is something that you can do.”
Naloxone, also known by the brand name Narcan, reverses the deadly effects of an overdose.