R384-210-2. Guidelines for the Issuance of a Prescription for an Opioid Antagonist Along with a Prescription for an Opioid

  (1) Co-prescribing guidelines are applicable when prescribing opioids.

  (2) Prescribers are encouraged to co-prescribe and opioid antagonist, such as naloxone; and to provide education on how to recognize an opioid overdose to patients, patient's household members and/or close contacts, when available, if factors exist that increase risk for opioid overdose, and households where preschool age children live or visit, whenever opiate medication is prescribed. Risks for opioid overdose include:

  (a) a known history of overdose;

  (b) a known history of substance use disorder;

  (c) a mental health condition that could make a patient susceptible to overdose;

  (d) a risk for returning to a high dose to which they are no longer tolerant (e.g., patients recently released from prison);

  (e) unstable medical conditions, such as respiratory disease, sleep apnea, cognitive decline medical conditions, or other comorbidities that make a patient susceptible to opioid toxicity, respiratory distress or overdose;

  (f) higher opioid dosages such as a dose greater than or equal to 50 Morphine Milligram Equivalents/day; and

  (g) concurrent benzodiazepine use.