Association Between Naloxone Co-Prescription Mandates and Post-Operative Outcomes.

INTRODUCTION: The opioid epidemic is a public health issue in the United States. The objective of this study was to evaluate the association between naloxone co-prescription mandates and postoperative outcomes.

SUMMARY BACKGROUND DATA: Data on naloxone co-prescription mandates show mixed evidence for fatal overdoses in the broader population. How these mandates have impacted surgical patients has not been fully explored.

METHODS: Healthcare claims data were used to identify all patients undergoing 1 of 50 common procedures between January 1, 2004 and June 30, 2019 and categorized as high-risk for opioid overdose. The primary outcomes were an emergency department visit or hospital admission within 30 postoperative days. To reduce confounding, the association between this outcome and the implementation of naloxone co-prescription mandates was estimated using a difference-in-differences approach.

RESULTS: The study included 429,878 surgical patients with an average age of 54.8 years (s.d. 15.9 y) and with 257,728 females (60.0%). There was no significant association between naloxone prescribing mandates and the primary outcomes. After adjustment for potential confounders, the incidence of a hospital admission was 3.26% after implementation of a naloxone co-prescription mandate compared to 3.33% before (difference change -0.08%, 95% CI -0.44% to 0.29%, P=0.68). The incidence of an emergency department visit was 7.06% after implementation of a naloxone co-prescription mandate compared to 7.73% before (difference -0.67%, 95% CI -1.39% to 0.05%, P=0.07). These results were robust to a variety of sensitivity and subgroup analyses.

CONCLUSION: Naloxone co-prescription mandates were not associated with statistically or clinically significant change in emergency department visits or hospital admissions within 30 postoperative days.