Prescriptions for opioid painkillers may come with another Rx, for naloxone
CHICAGO TRIBUNE | DEC 15, 2017 AT 2:25 PM
Patients who receive prescriptions for opioid painkillers at some Chicago-area hospitals might soon walk away with an additional prescription — for a drug meant to help them if they overdose.
In January, west suburban hospital system Edward-Elmhurst Health plans to start recommending its doctors prescribe naloxone with certain dosages of opioids. Naloxone, which is often sold under the brand name Narcan, can reverse the effects of an opioid overdose. When doctors prescribe certain doses of opioids, Edward-Elmhurst’s electronic system will prompt them to also check a box to prescribe naloxone.
Edward-Elmhurst might not be alone for long. Amita Health’s primary care doctors group of more than 130 physicians is considering co-prescribing naloxone and opioids and is expected to make a decision in the coming weeks, said Dr. Gregory Teas, chief of psychiatry for the Amita Health Behavioral Medicine Institute.
The changes come amid an epidemic of opioid abuse in Illinois and across the country. Hospitals and doctors have been trying a number of tactics and treatments to prevent deadly overdoses, including co-prescribing opioids and naloxone. Though questions remain about how many patients will fill those naloxone prescriptions, given their price, and whether they’ll actually use the overdose antidote, many Illinois physicians are eager to give anything that might save more lives a try.
In Illinois, 1,946 people died after overdosing on opioids in 2016, an increase of nearly 82 percent from 2013, according to the Illinois Department of Public Health. Nationwide, opioids were involved in the deaths of a record-breaking 33,000 people in 2015, according to the Centers for Disease Control and Prevention.
More than half of the deaths in Illinois involved heroin. Many others involved the types of painkillers often prescribed by doctors, such as morphine, hydrocodone and oxycodone.
Though opioids can be important tools in fighting pain, they also can be habit forming and lead to devastating addictions. Patients can develop tolerances to opioid drugs, leading them to take more over time to control their pain.
Doctors at Edward-Elmhurst hope that handing patients a prescription for naloxone — at the same time they’re prescribed higher dosages of opioids — will help prevent overdose deaths. “We feel like we’re on the cutting edge of change,” said Aaron Weiner, director of addiction services at Edward-Elmhurst Health.
Naloxone is already readily available to many Illinois residents, even without individual prescriptions. Illinois has what’s known as a “standing order” that allows pharmacies and certain programs to give the drug to patients who don’t otherwise have individual prescriptions for it.
But handing patients individual prescriptions for naloxone can raise awareness about the dangers of opioids, especially among those who might not realize they’re at risk, Weiner said.
In recent years, the CDC and the American Medical Association have recommended doctors consider co-prescribing opioids and naloxone, under certain circumstances, such as when patients have a history of substance abuse or also use certain other sedatives.
“For the AMA, the bottom line is naloxone saves lives,” said Dr. Patrice Harris, chair of the medical association’s opioid task force, which made its co-prescribing recommendation in 2015. There still isn’t much research on the effectiveness of co-prescribing, but one study, published last year in the Annals of Internal Medicine, found that when primary care doctors co-prescribed naloxone and opioids for chronic pain, patients less often wound up in hospital emergency rooms for opioid-related problems.
Live4Lali, an Arlington Heights-based group that works to raise awareness and prevent substance abuse, also recommends that doctors co-prescribe. It was founded after Executive Director Chelsea Laliberte’s brother, Alex "Lali" Laliberte, a Western Illinois University student who grew up in Buffalo Grove, died in 2008 from an overdose of heroin and other drugs.
“We’re grateful that prescribers and hospital systems are willing to accept that naloxone plays a role in their treatment plans,” Laliberte said.
Some, however, still have questions about widespread co-prescribing.
Dr. Michael Baldinger, medical director at Presence Saint Joseph Hospital’s Harborview Recovery Center, an addiction treatment center in Lakeview, said naloxone prescriptions might be a good idea for some patients, but he’s also wary of dispensing such prescriptions to all patients already getting help for addiction. Baldinger has been prescribing naloxone for about 10 years on a case-by-case basis to his patients and has seen the antidote save lives.
“You don’t want to give the message to the individual that you don’t have confidence in their sincerity as they’re entering into the recovery phase of their illness,” Baldinger said.
He also said it’s important doctors who co-prescribe sit down and talk with patients about how and when to use the naloxone. Naloxone also might not be very useful if patients’ loved ones don’t know they have it, or how to use it, he said. Patients generally can’t administer naloxone to themselves, because it’s typically given only after a person is showing signs of overdose, such as unresponsiveness.
There’s also the issue of cost. Before insurance, the nasal spray form of naloxone can cost more than $100, and an auto-injector version can cost thousands of dollars. In Illinois, Medicaid and many insurers cover various forms of naloxone, Laliberte said.
Weiner, with Edward-Elmhurst, agrees that educating patients on how and when to use naloxone is crucial. However, he doesn’t believe it sends a mixed message to patients when doctors co-prescribe naloxone and opioids.
Weiner hopes co-prescribing the drugs will bring the issue more into the open, erasing some of the stigma surrounding opioid addiction.
“The majority of the time, when parents come home to find their son or daughter dead, they had no idea this was going on,” Weiner said. “When it comes to addiction, no one is willing to talk about it, and I think that’s killing a lot of people.”