On April 15, 2021 MO HealthNet introduced a new High Risk Therapies Clinical Edit for patients receiving concurrent opioids and benzodiazepines.
The combination of opioids and benzodiazepines is considered a high risk therapy as both drugs cause sedation, impaired cognitive function, and respiratory depression potentially leading to an overdose death. Unfortunately, many patients are still prescribed this high risk therapy combination. In 2015, 23% of persons dying due to opioid overdoses also tested positive for benzodiazepines. Also, the number of patients prescribed both an opioid and a benzodiazepine increased by 41% between 2002 and 2014. In March 2016, the CDC released their Guidelines for Prescribing Opioids for Chronic Pain; further clarification of these guidelines was published in April 2019. These guidelines recommend avoiding the prescribing of benzodiazepines concurrently with opioids whenever possible. Also, both opioids and benzodiazepine prescription products now carry a boxed warning from the FDA highlighting the danger of using these agents together.
Naloxone is an opioid antagonist indicated for the emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression. Pharmacists in Missouri are able to dispense naloxone according to the statewide standing order or upon presentation of a valid prescription. As part of the efforts to protect participants from the possible adverse effects of combining opioid and benzodiazepine medications, MO HealthNet will impose clinical criteria to require the presence of an opioid emergency reversal agent, such as naloxone, when these agents are used concomitantly.
The current statewide standing order is available at: https://health.mo.gov/data/opioids/pdf/naloxone-standing-order.pdf
The current High Risk Therapies Clinical Edit is available at: https://dss.mo.gov/mhd/cs/pharmacy/pdf/high-risk-therapies-clinical.pdf