Naloxone co-prescription policies have been implemented in several states to address opioid overdose deaths, according to a March 30 report. These policies require or encourage healthcare providers to prescribe naloxone alongside certain opioid prescriptions, especially for patients at higher risk.
The issue is significant as more than one million people have died from an overdose in the United States over the last two decades, with over 150 deaths still occurring each day. Policymakers are seeking innovative solutions to reduce these numbers and improve access to lifesaving medications.
Naloxone is an opioid antagonist that can reverse the effects of an overdose if administered promptly. While U.S. pharmacies dispensed more than 120 million opioid prescriptions in 2024, only about 1.5 million naloxone prescriptions were filled that year. Co-prescribing mandates aim to increase access among those most at risk, such as individuals taking high doses of opioids or combining them with other central nervous system depressants.
States began enacting co-prescribing mandates in 2018. As of May 1, 2024, eleven states required medical professionals to co-prescribe naloxone under certain circumstances, while seven others required it be offered by a pharmacist or prescriber. Studies show that state-level mandates were associated with significant increases in naloxone dispensing rates shortly after implementation—for example, one study found rates were nearly eight times higher in mandate states compared to others. However, recent research suggests these increases may not always be sustained and do not consistently lead to reductions in overdose death rates.
Experts say this inconsistency may be due to the fact that most fatal overdoses involve illicit rather than prescription opioids and note that universal co-prescribing could increase costs without proportional benefit. Laws improving general access and programs focused on distribution and education are more consistently linked with reduced mortality among high-risk groups.
The report concludes that targeted naloxone co-prescription—focused on those prescribed high-dose or long-term opioids—can form part of a broader strategy against opioid-related deaths but should be combined with education efforts and low-barrier distribution programs for maximum effect.
