Naloxone is not a moral hazard — it's a good tool for physicians to have in their kits

Naloxone is not a moral hazard — it's a good tool for physicians to have in their kits
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A few years ago, a family physician friend of mine told me that one of his elderly patients overdosed from an opioid in her sleep. Thankfully, paramedics revived her with naloxone — the opioid-reversal agent.

My friend was shocked. She was a sweet old woman who was on a very low-dose opioid for intermittent pain. When my friend visited her in the hospital, she told him that she took her medication that night because if she took it during the day, it made her feel funny.

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But she never told her doctor that before. And she had sleep apnea, and she might have just had a cocktail or glass of wine with dinner, too.

 

This week, the U.S. Surgeon General released a public health advisory urging more Americans to carry naloxone. Surgeon General Adams, physicians, first responders and public health advocates all recognize that naloxone is a literal lifesaver and a vital tool in our fight against the opioid epidemic.

More than 64,000 people died last year from an opioid-related overdose. If it wasn’t for naloxone, the number would have been staggeringly higher. Recently, a pair of economists suggested that naloxone might be a “moral hazard” because it encourages people to take more risks.

As a physician and Chair of the American Medical Association’s (AMA) Opioid Task Force, I view naloxone as a medication that works to restore normal breathing to an individual suffering from an opioid overdose. A life saved is not a moral hazard.

The AMA encourages physicians to co-prescribe naloxone to patients at risk of overdose because of a few evidence-based reasons:

1. Co-prescribing naloxone has been found to reduce emergency department visits, and may help patients become more aware of the potential hazards of opioid misuse; and most important. 

2. Co-prescribing naloxone saves lives.

We are pleased that others (see here and here, for example) have identified the faults in the “moral hazard” theory, so I want to highlight for patients the reasons why a physician might recommend a co-prescription of naloxone to you — and by extension — when physicians might consider a co-prescription of naloxone. The AMA Task Force recommends that the physician consider:

  1. Does the patient history or prescription drug monitoring program (PDMP) show that my patient is on a high opioid dose?
  2. Is my patient also on a concomitant benzodiazepine prescription?
  3. Does my patient have a history of substance use disorder?
  4. Does my patient have an underlying mental health condition that might make him or her more susceptible to overdose?
  5. Does my patient have a medical condition, such as a respiratory disease, sleep apnea or other comorbidities, which might make him or her susceptible to opioid toxicity, respiratory distress or overdose?
  6. Might my patient be in a position to aid someone who is at risk of opioid overdose?

A life saved is a success, but we also recognize that access to naloxone is not the singular solution to ending the nation’s opioid epidemic. We must also or A necessary component is to  greatly improve access to treatment for substance use disorders as well as multidisciplinary pain care.

We hear all too often that after an overdose reversal, the patient overdoses again, or can’t find treatment. If we save a life but miss the opportunity to start the person on the path to recovery, we won’t reverse this epidemic.

The AMA is proud to have helped more than two dozen states enact laws over the past five years to increase naloxone access. We know we have much more work to do to have that success translate into meaningful recovery, and we’ll keep fighting for our patients every step of the way regardless of the terms used by economists. Co-prescribing naloxone is a good tool for physicians to have in their doctor kits — but only if we use it.

Patrice Harris, MD, MA is the chair of the American Medical Association's (AMA) Opioid Taskforce and is the immediate past-chair of the AMA’s Board of Trustees.