National Trends in Naloxone Co-Dispensing with Outpatient Opioid Prescriptions, 2013–2023

Abstract

Background: Increasing access to naloxone, an opioid antagonist, can prevent opioid overdose among patients prescribed opioids. In 2016, the Centers for Disease Control and Prevention recommended coprescribing naloxone with opioids; however, the extent to which this guideline influenced clinical practice remains unclear. In this study, we seek to describe trends in the rate of naloxone codispensing with opioid prescriptions from 2013 to 2023. Methods: This serial cross-sectional analysis used the IQVIA Longitudinal Prescription Database, which captures 92% of dispensed US retail prescriptions, to examine opioid prescriptions dispensed to individuals aged 12 years and older between January 1, 2013 and September 30, 2023. Naloxone codispensing was defined as naloxone dispensed within 3 days of the opioid dispensing date. Subgroup analyses included high-risk opioid prescriptions, long-term opioid therapy, and prior dispensing of buprenorphine for opioid use disorder. Results: From 2013 to 2023, 1 690 391 169 opioid prescriptions were dispensed, with naloxone codispensing occurring in 3 531 421 (0.2%) cases, increasing from 0.0% in 2013 to 0.9% in 2023. Naloxone codispensing increased from 0.0% to 1.3% among high-risk prescriptions, from 0.0% to 0.7% for long-term opioid therapy, and from 0.0% to 1.8% for prior buprenorphine recipients during the study period. Conclusions: In this analysis of a national prescription dispensing database, naloxone codispensing with prescription opioids increased for 2013-2023 but remained infrequent, even among individuals at elevated risk for opioid overdose. Although these data do not capture naloxone obtained through prior prescriptions or free distribution programs, these findings emphasize the need for targeted interventions to promote naloxone codispensing. Clinician education, policy measures, and continued community outreach may help increase naloxone uptake and improve access for at-risk patients.