Naloxone prescriptions to adolescents increased dramatically over the past few years but still are too low given rising rates of opioid overdoses, according to a new study.
“Pediatricians and other youth-serving clinicians can play an important role in expanding access to naloxone and harm reduction information by prescribing naloxone to all youth who are at risk for overdose,” authors from the Centers for Disease Control and Prevention wrote in the study “Naloxone Dispensing to Youth Ages 10–19: 2017–2022” (Terranella A, et al. Pediatrics. Sept. 12, 2024).
Teen overdose rates more than doubled from 2019-’21, driven largely by illegally made fentanyl, according to the study. In 2021, about 259,000 youths ages 12-17 had an opioid use disorder. Naloxone can be used to reverse an opioid overdose if it is given quickly enough.
Researchers sought to look at trends in dispensing naloxone to adolescents using a database representing 93% of all U.S. prescriptions. They analyzed data on adolescents ages 10-19 from 2017-’22, during which time 59,077 naloxone prescriptions were dispensed.
The rate of prescriptions dispensed increased 669% from about seven to 51 per 100,000 adolescents. But for every one naloxone prescription dispensed for youths, nearly 96 were dispensed for adults.
While naloxone dispensing increased nearly eight-fold for youths, opioid overdoses almost tripled during the same period.
Due to their relationship with youths, pediatricians have an opportunity to increase access to naloxone, according to study authors. Pediatricians wrote just 6% of the dispensed naloxone prescriptions for adolescents despite a 991% increase during the study period.
Authors said pediatricians should offer naloxone to “all youth who report substance use or who are at risk for an opioid overdose.” They encouraged residency training to address naloxone, as a study found only about one-third of pediatric residents knew when to prescribe it.
Pharmacies, emergency departments, hospitals, schools and youth organizations also can play a role in increasing access, authors said.
Cost may be a barrier for some youths. The study found about 20% of prescriptions dispensed had out-of-pocket costs above $25, including about 6% with out-of-pocket costs over $75. Authors suggested increasing enrollment of Medicaid-eligible youth and minimizing copays. They noted some may benefit by naloxone nasal spray being approved for over-the-counter use last year. These formulations cost an average of $45.
Authors of a related commentary went a step further than the study authors, calling for universal dispensing. They noted fentanyl can be found in drugs other than opioids and said broader prescribing could help remove the stigma.
“Like promoting the safe storage of firearms or encouraging every home to have a fire extinguisher, pediatricians should consider prescribing naloxone at every health maintenance visit to ensure the safety of patients and families,” they wrote.
Resources
- AAP resources to address the opioid epidemic
- Information for parents from HealthyChildren.org on opioids and using naloxone
- Information on free or reduced-cost naloxone through the NEXT Naloxone program
