OBJECTIVES: Opioid overdose (OOD) is a serious public health crisis in the US. Naloxone, an opioid antagonist, reverses opioid overdoses. Data on prevalence, demographics, and healthcare utilization of OOD and OOD at-risk individuals remain largely unreported. Naloxone prescriptions for these groups are examined.

METHODS: This retrospective analysis used anonymized Optum health claims data, included over 180 million covered lives from Commercial, Managed Medicare and Medicaid plans. Eligible patients were ≥ 18 years old with medical and pharmacy benefits and minimum 30 days continuous enrollment from January 2016 - December 2019. ICD-10 codes for opioid poisoning were used to identify the OOD population (OODP). The OOD at-risk population (ARP) was classified utilizing one or more CDC risk factor criteria, identified through use of both ICD-10 codes and NDC drug codes. NDC drug codes were used to identify individuals prescribed naloxone in both cohorts.

RESULTS: Of 7.87 million individuals included, prevalence of OODP declined by 9% from 2016-2019. In the same period, prevalence of ARP declined by 16%. In 2019, the largest group of OODP was aged 30-49 years (35%), male (53%), Caucasian (75%), and Medicaid beneficiaries (60%). In contrast, ARP were mostly aged ≥50 years (65%), female (61%), Caucasian (73%), and Medicare beneficiaries (70%). Only 20% of OODP and 5% of ARP received naloxone in 2019. Cost per opioid overdose episode was $3,200 for individuals on naloxone and $10,400 for those not.

CONCLUSIONS: This large retrospective analysis suggests that despite CDC guidelines and prevalence of opioid overdose and at-risk patients, naloxone remains under-dispensed, which may result in a high healthcare utilization burden. Preliminary data suggests that previously unrecognized populations appear to be at-risk and require further evaluation. Analysis of healthcare costs associated with at-risk populations and the impact of naloxone administration on disease state management and OOD-associated morbidity and mortality is ongoing.