June 22, 2021
There is no single solution to address the opioid crisis, but one thing is clear: Naloxone saves lives in emergencies. Expanding access to opioid overdose reversal medications like naloxone is one critical component of a broader strategy needed to combat increasing accidental overdoses in New York, and Gov. Andrew Cuomo has it on his desk to do so.
The U.S. Centers for Disease Control and Prevention reported nearly 90,000 drug overdose deaths in the 12-month period ending in October 2020 — the largest number for a 12-month period ever recorded. In New York alone, at least 20 counties and New York City have recorded overdose increases since the pandemic began, including my home county of Erie.
As an emergency physician and founder of New York MATTERS, I have long understood the critical need to create more effective linkages between hospitals and quality care, treatment, and existing resources for at-risk patients. The New York MATTERS program works to deliver efficient buprenorphine training to emergency physicians and provide take-home naloxone kits to at-risk patients and family members. Only by establishing such linkages to care can we create safer spaces for patient education and prepare individuals to manage their risk of accidental overdose. And it starts with naloxone.
Naloxone is an FDA-approved medication used to reverse the effects of an opioid overdose. But it can only be effective if it is available and present in situations that call for it. Our elected officials can take active steps to ensure that health care professionals meet patients where they are to educate them about their risk for accidental overdose and equip them with this tool.
The Legislature recognized this when it passed a bill (A.336/S.2966) that requires opioid prescribers to co-prescribe naloxone to certain at-risk patients, including those with opioid prescriptions of 50 morphine milligram equivalents (MME) or higher, a history of a substance abuse disorder, or concurrent use of benzodiazepines or non-benzodiazepine sedative hypnotics. It’s now on Cuomo to help protect more individuals from accidental overdose with the stroke of a pen.
We know co-prescribing policies work to increase access to naloxone for those at risk of an overdose. The New Mexico Department of Health reported in late 2020 that prescription opioid overdose deaths decreased statewide in 2019 when more than 94,000 doses of naloxone were dispensed or distributed, representing an increase of 95 percent from 2018. This increase in naloxone distribution correlated with the passage of SB 221, which required health care providers to co-prescribe naloxone when the patient is prescribed more than a four-day supply of opioids.
A co-prescription policy would also help to reduce the stigma that persists among those who are prescribed opioids and remain at risk. I still clearly recall one of my former patients — we were going through her medication history and without hesitation, she listed off her daily routine of antihypertensive drugs, but when she reached suboxone (buprenorphine and naloxone), she put her head down in front of the nurse and me in the closed room, as if ashamed. It’s just one example of the sensitivities many patients feel when discussing their treatment and care. Just like an overdose, it is an internal stigma that requires approaches from different angles to address. This legislation would empower health care professionals to equip at-risk patients with the potentially lifesaving medication in a safe environment, further increasing opportunities for patient-physician conversations around naloxone and the risk of overdose.
Just this April, New Jersey Gov. Phil Murphy signed co-prescribing legislation into law. What New Jersey and 10 other states have done is successfully put into place guardrails that respect the potential harms of opioids and empower prescribers to educate their patients about their risk of overdose and equip them with naloxone.
New York must follow suit, immediately.
Dr. Joshua Lynch is an emergency physician and EMS medical director from Buffalo, and the founder and medical director of New York MATTERS.