OBJECTIVES: CDC issued naloxone co-prescribing recommendations for AROODP. A US health care claims database was analyzed for AROODP rates, economic burden, comorbidities, and naloxone dispensing.

METHODS: This retrospective analysis used anonymized Commercial, Managed Medicare, and Medicaid patient claims from a US Optum database. AROODP included opioid overdose (≥50 MME/day), while others at-risk included both ≥50 or <50 MME/day with one or more of the following; respiratory illnesses/sedating medication/opioid and non-opioid SUD/mental health disorder/illicit opioid use/benzodiazepines/stimulant use/medication for opioid use disorder (MOUD), between Jan 2016 through Dec 2019. Patients >18 years with a minimum continuous enrollment of 30 days at index event (first claim date) were included. AROODP trends, Charlson-, the Agency for Healthcare Related and Quality (AHRQ 1, 2, and 3)-comorbidities at baseline, naloxone dispensing, and per member per month costs (PMPMC) were analyzed annually by insurance type.

RESULTS: During 2016 to 2019, 3,138,136; 3,206,908; 2,926,435; and 2,707,251 AROODP were identified, respectively. In 2019, 63.31% were >50 years, 51.64% Caucasian, 60.83% Female, 70.24% Medicare, and 3.28% Commercial. Overall, 98.21% of AROODP were not on MOUD while only 2.66% received at least a naloxone prescription. TX, FL, NY, CA, and NC states had highest AROODP rates. Between 2016-2019, there was a ~9.24% increase in AROODP rates among >50 years. Overall, disease specific PMPMC during 2019 were $2965.66 vs. $394.66, respectively. Most prevalent Charlson comorbidities included chronic pulmonary disease, diabetes with chronic complications, and malignancy. Commercial and Medicaid had Mental illnesses, Medicare had diseases of the circulatory system (AHRQ1). Additionally, Commercial had substance-related disorders, while Medicare and Medicaid had spondylosis and intervertebral disc disorders (other back pains) (AHRQ2) in 2019.

CONCLUSIONS: AROODP, demonstrated significant burden to the US healthcare system. Naloxone prescription remains sub-optimal. Increased naloxone co-prescribing may result in significant cost savings and lower resource utilization.