New guidelines from the US Department of Health and Human Services (HHS) recommend that naloxone should be prescribed or coprescribed with opioids to individuals at high risk of an overdose, including, but not limited to: individuals who are on relatively high doses of opioids, take other medications which enhance opioid complications, or have underlying health conditions.

The guideline also recommends that doctors should also educate patients and those who are likely to respond to an overdose, including family members and friends, on when and how to use naloxone.

The following patients should be prescribed or coprescribed naloxone:

• Are receiving opioids at a dosage of 50 morphine milligram equivalents (MME) per day or greater
• Have respiratory conditions such as chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea (regardless of opioid dose)
• Have been prescribed benzodiazepines (regardless of opioid dose).
• Have a non-opioid substance use disorder, report excessive alcohol use, or have a mental health disorder (regardless of opioid dose)

Patients at high risk for experiencing or responding to an opioid overdose have also been defined. These include individuals:

• Using heroin, illicit synthetic opioids or misusing prescription opioids
• Using other illicit drugs such as stimulants, including methamphetamine and cocaine, which could potentially be contaminated with illicit synthetic opioids like fentanyl
• Receiving treatment for opioid use disorder, including medication-assisted treatment with methadone, buprenorphine, or naltrexone
• With a history of opioid misuse that were recently released from incarceration or other controlled settings where tolerance to opioids has been lost

(Source: https://www.hhs.gov/opioids/sites/default/files/2018-12/naloxone-coprescribing-guidance.pdf)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA