Naloxone Co-Prescribing Documents Opioid Therapy Severity in PI Cases

Amar Lunagaria — Co-Founder & Chief Pharmacist, LienScripts | March 4, 2026 | 7 min read

When naloxone is co-prescribed alongside opioid therapy, it documents that the plaintiff's pain management regimen carries sufficient overdose risk to warrant an emergency rescue medication. This co-prescribing event is severity evidence that PI attorneys should present in demand packages.

A naloxone co-prescription alongside opioid therapy is clinical documentation that the plaintiff's pain management regimen is serious enough to warrant an emergency rescue medication for potential opioid overdose. Naloxone (brand name Narcan) reverses opioid overdose, and its co-prescribing is recommended by clinical guidelines when patients are on higher opioid doses or have risk factors for respiratory depression. The presence of naloxone in a plaintiff's medication profile is not a red flag -- it is evidence that the prescriber is managing a legitimately severe pain condition with appropriate safety protocols.

• Naloxone co-prescribing indicates that the plaintiff's opioid regimen is at a level where clinical guidelines recommend overdose prevention measures
• The co-prescription is a clinical safety decision that documents the severity of the opioid therapy required for the plaintiff's pain
• LienScripts tracks naloxone dispensing through its platform, and each case receives a MERIT (Medication Evaluation & Rationale for Injury Treatment) report that contextualizes naloxone within the opioid management plan
• Defense counsel may attempt to use naloxone co-prescribing to suggest excessive opioid use; plaintiff attorneys should reframe it as evidence of responsible, guideline-adherent prescribing
• The need for naloxone as a safety net demonstrates that the plaintiff's injury requires pain management at a level that carries inherent risk

When and Why Naloxone Is Co-Prescribed

Clinical practice guidelines, including those from the CDC and most state medical boards, recommend naloxone co-prescribing when patients meet certain criteria:

• Opioid dose at or above 50 MME/day -- the threshold at which overdose risk increases
• Concurrent benzodiazepine use -- the combination significantly increases respiratory depression risk
• History of overdose or substance use disorder -- though in PI cases, naloxone is typically prescribed based on dose rather than history
• Patient request or prescriber clinical judgment -- proactive safety measures

As Amar Lunagaria, PharmD, LienScripts' Chief Pharmacist explains, "Naloxone co-prescribing is standard of care. When a prescriber writes a naloxone prescription alongside an opioid, they are not signaling that something is wrong with the patient -- they are following clinical guidelines for safe opioid management. From an evidentiary standpoint, the naloxone prescription documents that the plaintiff's pain is severe enough to require an opioid dose that clinical guidelines flag for additional safety measures. That is severity evidence."

Reframing Naloxone as Severity Evidence

Defense counsel may seize on a naloxone prescription to suggest that the plaintiff's opioid use is dangerous, excessive, or indicative of substance misuse. Plaintiff attorneys should reframe naloxone co-prescribing as evidence of three critical points:

1. The Injury Requires Aggressive Pain Management

Naloxone is co-prescribed because the opioid dose is high enough to warrant it. The opioid dose is high because lower doses and non-opioid alternatives were insufficient for the plaintiff's pain. Therefore, naloxone co-prescribing indirectly documents that the plaintiff's injury is severe enough to require aggressive opioid therapy that exceeds standard thresholds.

2. The Prescriber Is Following Guidelines

A naloxone co-prescription demonstrates that the prescriber is adhering to clinical practice guidelines for opioid therapy. This undercuts any defense argument that the treatment is reckless or inappropriate. The prescriber is not only managing the plaintiff's pain -- they are doing so with the safety protocols that medical standards require.

3. The Plaintiff Bears an Additional Medication Burden

Naloxone is another medication the plaintiff must carry, store, and be prepared to use (or have a family member use) in an emergency. This additional burden -- carrying a rescue medication for a potential overdose of a pain medication prescribed because of the defendant's negligence -- is itself a quality-of-life impact and a component of the polypharmacy burden.

Naloxone in the Medication Timeline

The date naloxone is first prescribed is an important marker in the medication timeline. It typically correlates with one of these clinical events:

• Opioid dose escalation past 50 MME/day -- the prescriber adds naloxone when the opioid dose crosses the guideline threshold
• Addition of a benzodiazepine -- when a benzodiazepine is added for anxiety or muscle spasm alongside existing opioid therapy
• Policy implementation -- some states now require naloxone co-prescribing above certain MME thresholds

In any case, the naloxone start date documents a clinical inflection point where the plaintiff's treatment regimen became complex enough to require a safety intervention. This date should be highlighted in the treatment timeline presented in demand packages.

Presenting Naloxone Evidence in Demand Packages

Include naloxone co-prescribing in every demand package where it appears:

1. The naloxone prescription date -- correlating it with the opioid dose or clinical event that triggered co-prescribing
2. The clinical guideline basis -- citing the CDC or state guideline recommending naloxone at the plaintiff's opioid dose level
3. The severity inference -- explicitly stating that naloxone co-prescribing documents the severity of the opioid therapy required for the plaintiff's injury
4. The additional burden -- describing the practical impact of carrying and maintaining a rescue medication
5. Integration with the overall narrative -- presenting naloxone as part of the progressive treatment escalation from conservative therapy through aggressive opioid management

The MERIT report from LienScripts includes naloxone co-prescribing within the comprehensive medication analysis, with clinical commentary explaining its significance to the treatment plan.

Countering the "Dangerous Treatment" Argument

If defense counsel argues that naloxone co-prescribing proves the plaintiff's treatment is dangerously aggressive, the rebuttal is direct: the need for naloxone exists because the defendant caused injuries severe enough to require high-dose opioid therapy. The plaintiff did not choose to be on opioids at a level requiring a rescue medication. The defendant's negligence created the injuries that necessitate this level of pain management.

Furthermore, the presence of naloxone demonstrates that the prescriber is practicing responsible medicine -- monitoring risk and providing safety measures. This is the opposite of the reckless prescribing narrative that defense counsel may attempt to construct.

Practical Takeaways

Naloxone co-prescribing is a clinical safety measure that doubles as severity evidence. It documents that the plaintiff's injury requires opioid therapy at a level where clinical guidelines mandate overdose prevention measures. Attorneys who present naloxone evidence properly reframe a potential defense attack into an affirmative demonstration of injury severity and responsible medical management.

LienScripts generates a MERIT (Medication Evaluation & Rationale for Injury Treatment) report for every case, providing pharmacist-signed documentation for demand packages that includes naloxone co-prescribing analysis with clinical context.

Related Resources

• MME: What Attorneys Need to Know -- Understanding opioid dose measurement
• Polypharmacy Burden as a Damages Element -- The daily toll of managing multiple medications
• What Is a MERIT Report? -- Understanding the pharmacist-authored clinical summary