Anti-overdose drug naloxone (Narcan) isn't getting to enough at-risk and rural people, including many counties in Kentucky

CDC maps show rate of naloxone prescriptions (top) and ratio of naloxone prescriptions to high-dose opioid prescriptions; darker areas are more likely to have sufficient access to naloxone.

Use of the opioid-overdose rescue drug naloxone, also known by the brand name Narcan, has boomed in recent years. However, too few chronic-pain patients at high risk of overdose are receiving it, especially in rural America, including parts of Kentucky, Christine Vestal reports for Stateline.

In 2017, 47,600 Americans died from an opioid overdose. According to a new report from the federal Centers for Disease Control and Prevention, more lives could be saved if health-care providers offered naloxone to all patients at risk of overdose. "Naloxone dispensing from retail pharmacies increased from 2012 to 2018, with substantial increases in recent years. Despite increases, in 2018, only one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. The lowest rates of naloxone dispensing were observed in the most rural counties."

Enlargement of Kentucky and neighboring states shows naloxone access; Kentucky counties with the first rank of access are Adair, Anderson, Bell, Boyd, Breathitt, Bullitt, Campbell, Christian, Estill, Fleming, Floyd, Franklin, Grant, Hopkins, Jackson, Johnson, Laurel, Lawrence, Leslie, Lewis, Martin, Menifee, Owsley, Pendleton, Pike, Powell, Scott, Trigg and Union.

According to the report, overall naloxone dispensing was 25 times greater in the highest-dispensing counties than in the lowest-dispensing counties. The number of naloxone prescriptions rose from 270,000 in 2017 to 556,000 in 2018, but it would take 9 million prescriptions to provide one to every person who has a high-dose opioid prescription, the report found.

"The CDC’s 2016 guidelines for prescribing opioids for chronic pain recommended doctors prescribe naloxone for all patients taking more than the equivalent of 50 mg of morphine a day. Since then, a handful of states have required doctors to co-prescribe naloxone and warn patients about the risk of high doses of opioids," Vestal notes. "In addition, nearly all states have enacted so-called good Samaritan laws, allowing private citizens to administer the overdose-reversal medication without legal liability. And most states in the past five years have called on pharmacies to provide the easy-to-administer medication to anyone who wants it without a prescription, according to the Network for Public Health Law."