P3A043: Naloxone Dispensing to Youth, Ages 10-19 Years in the United States, 2017-2022

Background: Naloxone is an important harm reduction tool for people who use drugs, including adolescents. Adolescents who use drugs are at risk of overdose, and mortality rates among adolescents from synthetic opioids including illicitly manufactured fentanyl have risen rapidly over the past several years. Despite the lifesaving effects of naloxone, it is not administered in most opioid overdose deaths among adolescents. Youth serving clinicians can play a role in expanding naloxone access by offering it to all youth at risk of opioid-involved overdose including by prescription. Few clinicians discuss overdose prevention with patients, and naloxone prescribing to youth is low. A better understanding of prescribing and dispensing practices to youth could inform overdose prevention education for clinicians. To our knowledge, no nationally representative studies of naloxone dispensing to youth have been published to date.

Methods: We used IQVIA National Prescription Audit New to Brand data, which contains prescriptions dispensed from approximately 48,900 retail pharmacies, representing 93% of all prescriptions from all payers in the United States, to describe naloxone dispensing trends in youth aged 10-19 years from 2017-2022. These data include all payers and are projected to be nationally representative of all prescriptions dispensed from U.S. retail pharmacies. Cross-sectional analyses were used to describe naloxone dispensing trends over time and by sex and prescriber specialty.

Results: From 2017-2022, 59,077 (annual mean, 9846) prescriptions for naloxone were dispensed to youth aged 10-19 years. This corresponds to 0.24 prescriptions per 1000 youth per year. Dispensing increased 689% from 2017-2022, with increases each year. General practice physicians including physicians whose specialty was not specified accounted for 16.5% of naloxone prescriptions, followed by nurse practitioners (14.2%), surgical specialists (12.7%), family physicians (9.5%) and physician assistants (9.2%). Pediatricians (including internal medicine/pediatrics specialists) prescribed 5.6% of naloxone dispensed. Pediatricians account for an increasing proportion of prescriptions dispensed with a 6-year increase of 991% compared to an overall 689% increase in prescriptions. While pharmacists prescribed a small share (4.3%) of dispensed naloxone prescriptions, they were among specialties with the largest increases over the study period (2575%).

Conclusion: The total number of naloxone prescriptions dispensed to youth aged 10-19 years was low but increased over the study period. Pediatricians and pharmacists prescribed a small but increasing proportion of naloxone dispensed. Limitations to this study include the inability to capture naloxone prescribed but not dispensed, prescriptions dispensed from hospital pharmacies and those directly distributed in clinician offices or in the community. Increasing availability through recent FDA over-the-counter actions could increase availability of naloxone to adolescents. Increased prescribing by clinicians including pediatricians and pharmacists can still play a role in increasing adolescents' access to naloxone through education and increasing awareness, and stigma reduction and can be an important component of community naloxone distribution plans.