New California Bill Requires Doctors to Prescribe Overdose-Reversing Drug

A new bill signed by Gov. Jerry Brown Monday requires doctors in California to provide additional medication when prescribing an opioid. Opioids, also known as prescription painkillers, are prescribed for post-surgical procedures, malignant-induced pain, patients who are experiencing pain while on hospice care, and in emergency/trauma settings. Opioids are also prescribed in the outpatient setting for individuals with acute and chronic pain, which has dramatically led to the opioid epidemic. The Center For Disease Control (CDC) recommends that if opioids are prescribed in the outpatient setting, the lowest dose possible should be prescribed for the least amount of time in order to prevent any form of dependence or addiction. However even with strict guidelines from The Center For Disease Control (CDC) and the American Medical Association (AMA), individuals are still becoming addicted to opioids and losing their lives from an opioid overdose. Opioid-reversing medication such as naloxone works to unbind opioids from their receptors resulting in a reversal of symptoms, which can potentially save lives if administered in a timely manner. Naloxone can be delivered via nasal mist or injection and can temporarily suspend the effects of the overdose until emergency responders arrive. Earlier this year, the Surgeon General advised that individuals, including family, friends and those who are personally at risk for an opioid overdose, carry naloxone on hand, in case of an emergency. This new California bill will require more lay people, who are at risk of opioid overdose, to carry naloxone on hand, in an effort to save lives. Prices vary depending on location and the buyer, but intramuscular naloxone costs about $20, while intranasal naloxone costs about $35. The price of a new auto-injectible naloxone, Evzio, is thousands; yes thousands of dollars for individuals who are uninsured.

“Assembly Bill 2760 says doctors must prescribe an overdose-reversing medication:

  • If the opioid prescription is equivalent to 90 or more morphine milligrams
  • If an opioid prescription is prescribed concurrently with a prescription for benzodiazepine
  • If the patient has an increased risk of overdose.

If they don’t follow this law, doctors could face administrative sanctions by the licensing board”.

Opioids are a class of drugs that include medications, such as oxycodone, hydrocodone and methadone, which are commonly prescribed to treat pain. Pharmaceutical fentanyl is a synthetic opioid which is 50 times more potent than heroin and 100 times more potent than morphine. According to statistics, opioid dependence affects approximately five million individuals in the United States each year and is responsible for 17,000 deaths each year in the U.S. The abuse potential for opioids begins at a young age, usually during adolescence or early adulthood and continues into middle and late adulthood. Americans make up approximately five percent of the world’s population but is responsible for 80% of the consumption of the world’s opioid supply and therefore have one of the largest opioid crises in the world. Prescription opioids are majorly responsible for this crises resulting in 46 deaths per day in 2012.

There has been much controversy regarding whether naloxone should be sold over-the-counter. Many believe that visiting a doctor’s office can be a barrier for receiving naloxone since doctor’s appointments usually requires insurance and taking time off work. However, enforcing physicians in California to prescribe this opioid antidote in certain circumstances is a step in the right direction for combating the opioid epidemic. It is equally important that individuals learn how and when to properly use naloxone. This education should be give by both physicians and pharmacists.