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New York doctors now have to prescribe naloxone for some patients on opioid pain relievers

Arnold Wilson wouldn’t have been able to walk half a block without opioid painkillers to ease pain in his knees and other joints. A 63-year-old former New York City nurse with crippling arthritis takes OxyContin twice daily and Oxycodone when additional relief is needed.

Over the past few years, he’s also had another drug on hand. Naloxone, an overdose reversal drug Often referred to by the brand name Narcan.

While overdose deaths from illicit drugs sold on the street make headlines, the risk of overdose is also real for patients taking doctor-prescribed opioids.

“It gives me a sense of security and peace of mind,” said Mr. Wilson, who keeps Narkan nasal spray in his car and at home. His pain management doctor at his Montefiore Medical Center in the Bronx prescribed opioids in 2013. After a bout of meningitis exacerbated joint problems Wilson had as a result of his two brain aneurysms and several strokes. His doctor advised him to start having Narkan in 2017.

Naloxone, which begins to reverse an overdose within minutes, is usually administered by someone else. She “taught her how to do it in case she got lethargic,” he said. His girlfriends and friends also know what to do.

Recently enacted New York legislation aims to make naloxone available to people like Wilson who take prescription opioids if needed.

under the lawThe law, which went into effect this summer, requires physicians to co-prescribe naloxone to certain patients at risk of overdose each year when making the patient’s first opioid prescription. Risk factors leading to the requirement include taking high daily doses of opioids (at least 90 milligrams of morphine equivalent, or MME). Taking certain other medications, such as sedative-hypnotics. or have a history of substance use disorders.

at least Ten other states have similar laws, According to a survey of Public Health Law Network.

“Patients, especially those taking opioids long-term, may not understand the risks,” said Laila Khalid, M.D., co-director of the Chronic Pain Clinic at Montefiore Medical Center. The clinic provides naloxone free to patients through the state’s Opioid Overdose Prevention Program.

For example, some people accidentally drink too much or drink extra at parties because they forget when they last had a drink, Khalid said. Some drugs, such as alcohol and benzodiazepines, amplify the effects of opioids.

Emily Einstein, director of the Science Policy Division at the National Institute on Drug Abuse, said, “Drug overdose deaths have continued to rise nearly every year for more than two decades. Einstein said preliminary data from the Centers for Disease Control and Prevention. The estimated number of overdose deaths in the U.S. will surpass 100,000 for the first time in 2021, according to Einstein, who estimated that the majority of the more than 80,000 deaths were due to opioids, according to this preliminary data. Most of the time Death from an opioid overdose was due to illegal fentanylapproximately 17,000 deaths were associated with prescription opioids, including methadone.

Naloxone, available either as a nasal spray or injection, is considered Safe and with few side effectsIt is not addictive.of Recommended by CDC Persons at risk of overdosing should have it available for family members or bystanders to administer if needed.

Drug policy experts point to key statistics that laws like New York are trying to address. Another person is in nearly 40% of his overdose deaths, according to the CDC.

If bystanders had naloxone, ‘most of those people wouldn’t have died,’ says Corey Davis, director Harm Reduction Legal Project In the public health law network.

in all statesincluding New York, pharmacists are licensed to dispense naloxone and oftenstanding orderAllowing dispensing without a prescription, usually to those at risk of overdose or in a position to help those at risk.

So why should doctors write scripts?

Experts say mandates are more effective than recommendations. By requiring doctors to prescribe the drug, more people who may need naloxone will get it if they fill out a prescription. is not.

Prescriptions also help remove the lingering stigma of asking for an overdose of medication at the pharmacy counter.

“It removes friction points,” says Davis. “You just go through the window and pick it up.”

and 2019 analysisPharmacists in states requiring concurrent naloxone and opioid prescriptions created approximately eight times as many naloxone prescriptions per 100,000 pharmacists in states not requiring it.

Missouri doesn’t have a joint prescription, but Danielle Muscat’s pain management doctor recently suggested she had Narcan. I am taking several medications to control my chronic severe back pain. She’s happy to keep her nasal spray in her bag just in case.

“I think it’s great” that people carry it around and know how to use it, she said.

Since New York’s law went into effect, “we’ve definitely seen more prescribers adding naloxone to their opioids, especially for larger orders,” said Ambar Keluskar, pharmacy manager at Rossi Pharmacy in Brooklyn. I’m here.

That said, Toni Tompkins, pharmacist at Phelps Hometown Pharmacy in the upstate New York town of Phelps, says patients don’t always understand why they’re getting it. .

A two-dose package of naloxone spray typically costs about $150. The drug is now available in generic form, which can reduce your out-of-pocket costs. Most insurance companies will cover it, but patients usually pay out-of-pocket. Naloxone is usually available to the uninsured through state programs.

In New York, private insurance companies are required to cover naloxone, and Medicaid covers it, said Monica Pomeroy, a spokesperson for the state health department. N-CAP) covers out-of-pocket costs of up to $40 for those with insurance, Pomeroy said. Those who don’t have insurance, or whose deductible hasn’t been met, can get it for free at her one of the state’s opioid overdose prevention sites.

In November FDA announced Considering making naloxone available without a prescription.

Offered at the window Some people worry that because of the increased availability of the drug, insurance will not cover it. Plus, “if a patient just picks it up somewhere without receiving guidance on how to use it, that can be a downside,” says vice president of professional affairs for the American Pharmacists Association. Ann Burns says.

Some experts believe that all opioid prescriptions should be naloxone-free, regardless of risk factors. That’s what’s happening in Rochester, New York and the surrounding Monroe County. In 2021, it was signed by county administrator Adam Bello. maisie’s lawnamed after local 9 month old girl He died after swallowing a methadone tablet found on the floor of his neighbor’s kitchen.

“What happened is terrifying,” said Karl Williams, a professor of pharmaceutical law and president of the New York State Pharmacists Association.


KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.

https://www.cbsnews.com/news/naloxone-prescriptions-opioid-painkillers-new-york/ New York doctors now have to prescribe naloxone for some patients on opioid pain relievers

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