Data Watch: Naloxone Prescription in Response to the Opioid Epidemic in Arkansas – Arkansas Center for Health Improvement – ACHI

Analysis of Naloxone Dispensing Trends in Arkansas: A Report on Progress Towards Sustainable Development Goal 3

Introduction: Policy Framework and Alignment with Global Health Objectives

In a direct effort to address the public health crisis of the opioid epidemic, the state of Arkansas has implemented key legislative measures. These actions align with the United Nations Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. Specifically, these policies support Target 3.5: “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse.”

The primary policies under review include:

1. Act 651 of 2021: Mandates the co-prescription of the overdose-reversal drug naloxone for patients receiving opioid prescriptions of 50 or more morphine milligram equivalents (MME) per day. This measure directly contributes to SDG Target 3.4, which seeks to reduce premature mortality.
2. 2017 State Protocol: Authorized licensed pharmacists to dispense naloxone without a prescription, thereby improving access to essential, life-saving medicine in line with SDG Target 3.8 (Achieve universal health coverage and access to quality essential medicines).

This report analyzes data from the Arkansas All-Payer Claims Database for state fiscal years (FY) 2017 through 2024 to evaluate the impact of these policies on public health outcomes and progress towards SDG 3.

Key Findings: Measuring Advancement in Public Health and Well-being

The analysis reveals several trends that indicate progress in managing the opioid crisis and advancing the objectives of SDG 3.

Overall Prescription Trends (FY 2017-2024)

• Reduction in Opioid Prescriptions: A consistent decrease in the percentage of enrollees filling opioid prescriptions was observed from FY 2017 to FY 2024. In the most recent period, the rate fell from 9.3% in FY 2023 to 8.5% in FY 2024, demonstrating positive momentum towards SDG Target 3.5.
• Increased Access to Naloxone: Over the same period (FY 2017-2024), the number of enrollees who filled naloxone prescriptions increased, reflecting successful efforts to expand access to this critical medicine as outlined in SDG Target 3.8.
• Short-Term Naloxone Fluctuation: From FY 2023 to FY 2024, a 25.4% decrease in naloxone prescription fills was noted. This may indicate that existing community supply and access points are meeting demand, a sign of a maturing public health response.

Impact of Co-Prescription Mandates on High-Risk Populations

The data shows a significant increase in naloxone co-prescribing for individuals with high-dosage opioid prescriptions, a key strategy for reducing premature mortality (SDG Target 3.4).

• 50+ MME Group: Among enrollees with opioid prescriptions of 50 or more MME per day, the rate of naloxone co-prescribing fills surged from 0.1% in FY 2017 to 14.6% in FY 2024.
• 90+ MME Group: For the highest-risk group, those with prescriptions of 90 or more MME per day, the co-prescribing fill rate increased from 0.1% in FY 2017 to 17.8% in FY 2024.

Strengthening Healthcare Access Through Pharmacist-Initiated Dispensing

The 2017 policy empowering pharmacists has proven effective in broadening access to naloxone, contributing to the goal of universal access to essential health services (SDG Target 3.8).

• In FY 2024, pharmacist-initiated actions accounted for 3,262 of the 19,833 total naloxone prescription fills, representing a significant 16.4% of all dispensations.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   The primary Sustainable Development Goal (SDG) addressed in the article is:

   • SDG 3: Good Health and Well-being

   Explanation: The article focuses entirely on public health issues, specifically the opioid epidemic. It discusses policies and measures, such as expanding access to the overdose-reversal drug naloxone, aimed at preventing deaths and mitigating the health crises associated with substance abuse. This directly aligns with SDG 3’s objective to “ensure healthy lives and promote well-being for all at all ages.”

2. What specific targets under those SDGs can be identified based on the article’s content?

   Based on the article’s focus, the following specific targets under SDG 3 are relevant:

   • Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

   Explanation: The article directly addresses this target by detailing Arkansas’s policy responses to the opioid epidemic. The implementation of Act 651, which requires co-prescription of naloxone with high-dose opioids, and the authorization for pharmacists to dispense naloxone without a prescription are concrete actions aimed at strengthening the treatment and prevention of consequences associated with narcotic drug abuse.

   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   Explanation: Opioid overdose is a significant cause of premature mortality. The policies described in the article, designed to increase the availability of naloxone, are a direct intervention to prevent these deaths. By tracking the increase in naloxone co-prescribing rates, the article highlights efforts that contribute to the reduction of premature mortality through treatment and prevention.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   Yes, the article provides several quantitative data points that serve as indicators to measure progress towards the identified targets.

   • Indicator for Target 3.5: The rate of naloxone co-prescribing for high-dose opioid prescriptions.

     Explanation: The article states that “Among enrollees who filled opioid prescriptions of 50 or more MME per day, the rate of fills from naloxone co-prescribing increased from 0.1% in FY 2017 to 14.6% in FY 2024.” This specific metric measures the implementation and reach of a key policy designed to prevent overdose, thus indicating progress in strengthening treatment for substance abuse.

   • Indicator for Target 3.5: The percentage of naloxone prescriptions initiated by pharmacists.

     Explanation: The finding that “In FY 2024, 3,262 out of 19,833 naloxone prescription fills, or 16.4%, were initiated by pharmacists” serves as an indicator of expanded access to treatment, a key component of strengthening prevention and treatment systems.

   • Indicator for Target 3.4 & 3.5: The percentage of enrollees filling opioid prescriptions.

     Explanation: The article notes that “The percentage of enrollees who filled at least one opioid prescription decreased from 9.3% in FY 2023 to 8.5% in FY 2024.” This trend suggests a reduction in the population at risk for opioid dependency and overdose, which is a preventive measure contributing to the reduction of premature mortality and the strengthening of substance abuse prevention.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

   SDGs	Targets	Indicators
   SDG 3: Good Health and Well-being	3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse.	Rate of naloxone co-prescribing for opioid prescriptions of 50 or more MME per day (Increased from 0.1% in FY 2017 to 14.6% in FY 2024). Rate of naloxone co-prescribing for opioid prescriptions of 90 or more MME per day (Increased from 0.1% in FY 2017 to 17.8% in FY 2024). Percentage of naloxone prescription fills initiated by pharmacists (16.4% in FY 2024).
   SDG 3: Good Health and Well-being	3.4: Reduce by one-third premature mortality from non-communicable diseases through prevention and treatment.	Percentage of enrollees who filled at least one opioid prescription (Decreased from 9.3% in FY 2023 to 8.5% in FY 2024). Overall increase in the number of enrollees who filled naloxone prescriptions from FY 2017 to FY 2024.

Source: achi.net