Commentary: Prescribe Naloxone along with patient’s opioids

By Michael Ninburg

For The Herald

At the Hepatitis Education Project in south Seattle, we see the effects of the opioid crisis every day.

We hear stories from our syringe-exchange clients about accidental overdoses and deaths. We are also doing what we can to help ameliorate the crisis by distributing free kits of Naloxone, the opioid overdose antidote.

As the contours of the opioid crisis facing our country have evolved over time, it is important that we continue to innovate in our public health response locally. This means building closer collaboration between social service organizations and clinical health care providers; but it also means wider availability of evidence-based interventions, such as Naloxone.

In 2017, the number of deaths related to opioid overdose were six times greater than in 1999. The most vulnerable individuals in our community are experiencing a disproportionate share of this epidemic. Medicaid patients are prescribed opioids at twice the rate of the general public and are at three to six times the risk of prescription overdose. In Washington state, one study found that 45 percent of people who died from a prescribed opioid overdose were Medicaid enrollees. Nationally, we know that over 80 precent of prescription opioid overdose deaths are accidental.

Over time, we know that rising to the challenge of a public health emergency of this scale requires closer collaboration among public health, first responders, social service agencies and clinical health care providers. Some regional local governments have already started piloting innovative solutions that treat people with dignity and respect by co-locating recovery services with resources that promote longer-term economic stability and housing. Low-acuity emergency response partnerships have been formed that focus on helping people struggling with opioids find a pathway to recovery instead of jail time.

Unfortunately, all the resources in the world won’t make a difference to people struggling with opioids, if they don’t have access to drug treatment on demand, opiate substitution therapy and Naloxone. A recent study by the National Institutes of Health highlights the powerful impact of this emergency solution. The NIH found that patients who were co-prescribed Naloxone had 47 percent fewer emergency room visits after xi months and 63 percent fewer visits after 1 year than patients who were not. The University of New Mexico pain clinic recently changed its internal prescribing policy to add Naloxone co-rx as a “universal precaution” for all its patients, due to the significant reduction in adverse events for their patients after they expanded Naloxone access and use.

Motivated by the alarming rise in opioid overdose deaths, Washington state is implementing a new law passed by the Legislature that makes changes to how opioids are prescribed, monitored and treated.

The new prescribing guidelines resulting from the law are intended to reduce the number of people who inadvertently become addicted to opioids and decrease deaths resulting from their use by co-prescribing Naloxone for certain at-risk patients. Beginning Jan. 1, prescribers are supposed to engage and assess their patients and co-prescribe Naloxone to patients who may be at risk of overdose.

The evidence is clear that prioritizing harm reduction in the fight against the opioid crisis helps people recover their lives, their loved ones and their autonomy. As we think about the next steps in response, we have to build on this foundational truth.

Helping people struggling with opioids is everyone’s responsibility – friends and family, co-workers and neighbors. Expanding access to emergency interventions such as Naloxone increases the chance that someone will have a lifeline when they need it most. By working with more compassion and empathy, we can help prevent needless deaths and help those in need live more productive and fulfilling lives.

Michael Ninburg is the executive director of the Hepatitis Education Project, a Seattle-based regional non-profit that works to improve the health of underserved communities disproportionately affected by viral hepatitis. Ninburg also serves as the president of the World Hepatitis Alliance, an organization that works across 89 countries with the goal of eliminating hepatitis by 2030.