Prescribing Alert Increases Rates of Naloxone, Opioid Co-Prescriptions


The alert was implemented after passage of a state senate bill.

After the passage of New Mexico Senate Bill 221 (SB 221), requiring a naloxone prescription dispensed with any opioid prescription of at least 5 days, The University of New Mexico Hospital incorporated Department of Health and Human Services criteria to identify patients at an increased risk for opioid overdose—including 24-hour morphine milligram equivalents (MME) greater than 50 mg, or benzodiazepine usage—to create a naloxone co-prescribing alert.

In order to evaluate the success of this naloxone prescribing alert in the University of New Mexico Hospital system, researchers conducted a retrospective study of patients aged 18 years or older who either had the alert on an opioid prescription or who would have met criteria for the alert. Alert criteria included an opioid prescription of at least 4 days, 24-hour MME greater than 50 mg, benzodiazepine co-prescription (even if the first two criteria are not mote) and no active naloxone prescription within the past year.

Prescription data were collected from January 1 through January 31 2019, Group 1, before passage of SB 221; January 1 through January 31, 2022, Group 2, after passage of SB 221 but before the alert was created; and March 31 through April 30, 2022, Group 3, after the alert was created (n=4689, 3667, and 4022, respectively). Data included patient demographics, 24-hour MME, total opioid and naloxone prescriptions, and benzodiazepine prescriptions.

The primary study outcome was the total number of naloxone prescriptions, and the prevalence of each component of the alert criteria.

Researchers found that the increases in naloxone prescriptions for patients that either met alert criteria in Groups 1 or 2, or who had the alert fire in Group 3, were significant between groups—from 1.6% to 8.8% to 23.8%. The number of opioid prescriptions that either met the criteria or triggered the alert (Groups 1 and 2 and Group 3, respectively), decreased between groups from 66.8% to 34.5% to 21.5%.

After the passage of SB 221, there were no differences in the number of opioid prescriptions with an MME greater than 50 mg or a concurrent benzodiazepine prescription; however, there was an increase in opioid prescriptions with a duration of longer than 5 days in group 3 (64.5%). No differences in MME were noted between groups.

“Though New Mexico SB 221 had significant impact on naloxone and opioid prescribing within the UNMH system, implementation of a naloxone co-prescribing alert led to a further significant increase in naloxone prescriptions,” the researchers concluded.

1. Wilson J. Impact of a naloxone prescribing alert on New Mexico state opioid regulation compliance. Presented at: American Society of Health-System Pharmacists 2023 Summer Meetings & Exhibition; June 10-14, 2023; Baltimore, MD. Poster 23-T.
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