Drug overdose deaths have reached epidemic proportions in the United States; overdose now outranks motor vehicle crashes as the number one cause of unintentional injury deaths. Nationally, prescription opiate overdose death rates have nearly tripled since 1999. California has seen similar increases, and is now seeing an increase in heroin deaths as well.
The California Department of Public Health is just one of many state and local agencies who have a stake in reversing these alarming trends, in partnership with health care providers, local health departments, patients, families, and communities. One powerful tool for California physicians and other prescribers is naloxone, the opiate antagonist which quickly reverses overdose and counteracts the potentially fatal respiratory depression opiates may cause.
On March 14, 2014, the California Department of Health Care Services (DHCS) released a bulletin announcing that naloxone has been added to the Medi-Cal formulary, and encouraging the routine provision of take-home naloxone to patients who are prescribed long-term and/or high dose opioids. The letter specifies that naloxone is covered by Medi-Cal, and that other health plans, including Medicare, also cover naloxone. DHCS recommends that naloxone be considered for any patient on chronic opioids. Prescribers may also prescribe naloxone to any patient they know to be using opiates non-medically, and provide brief instruction on its use. A Centers for Disease Control and Prevention report on naloxone administration by lay people (primarily drug users and their families) tallied over 10,000 overdose reversals reported since the initiatives began in 1996.1
The letter from Dr. Neal Kohatsu, DHCS Medical Director, can be found at the California Department of Health Care Services website: (http://files.medi-cal.ca.gov/pubsdoco/BULLETINS/docs/Letter_22470.1.pdf). Detailed information on dosing and administration of naloxone can be found at the Prescribe to Prevent website: (http://prescribetoprevent.org/). This website also features overdose prevention information for non-health care settings, community members, family members, and patients.
Original signed by Ron Chapman
Ron Chapman, MD, MPH
Director and State Health Officer
1 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm)