Variety of Factors Limit Clinicians Willingness to Prescribe Naloxone
Clinicians say they worry about offending patients.
A new Kaiser Permanente report indicates that a variety of factors may limit clinician willingness to prescribe naloxone, a potentially life-saving medication that counteracts the effects of opioid overdose. The findings of the study were published in the Journal of General Internal Medicine.
Naloxone is a narcotic antagonist that rapidly reverses the effects of opioid overdose and can be administered via the IV, IM or SC routes.
In 2014, the Food and Drug Administration (FDA) approved Evzio, the first hand-held auto-injector that quickly delivers a single dose of naloxone 0.4mg. It is available to patients, family members or caregivers via prescription, and can be carried in a pocket or stored in a cabinet. A study of 30 patients showed that a single injection of Evzio provided equivalent naloxone compared to a single injection given via a standard syringe.
Researchers from Kaiser Permanente, Denver Health Medical Center and the University of Colorado School of Medicine conducted 10 focus groups with 56 clinicians from August 2013 to August 2014. These focus groups obtained feedback on attitudes about prescribing naloxone to patients also taking opioids prescribed for pain at internal medicine, family medicine, and HIV clinics. Key findings include:
- Clinicians commonly expressed beliefs that naloxone could effectively prevent overdose deaths. Prescribing the drug may increase patient understanding of the risks associated with opioid use.
- Only three of the 37 clinicians with prescribing authority had prescribed naloxone.
- There were logistical challenges, such as time restraints within clinical appointments, to widespread naloxone prescribing in busy primary care practices.
- Clinicians were hesitant to prescribe naloxone. They did not want to offend patients by talking to them about their risk of overdose.
- Clinicians wanted to be certain that the bystanders who would actually deliver naloxone receive proper and confidential training, and are able to recognize the signs of an overdose.
- Clinicians expressed concerns about possible adverse effects of the drug in widespread use. Focus group participants wanted evidence that having naloxone available does not lead to riskier use of opioids.
Since 1999, the number of fatal overdoses from opioid medication has quadrupled in the U.S., with 44 people dying from prescription painkiller overdoses daily according to the Centers for Disease Control and Prevention.
"Given the substantial increase in fatal overdoses from pharmaceutical opioids in the U.S. in recent years, expanding access to naloxone is a promising option to prevent future deaths," said lead study author Ingrid Binswanger, MD, MPH, senior investigator for Kaiser Permanente Colorado's Institute for Health Research. "However, research shows there are gaps in knowledge about how to use naloxone in routine clinical practice. It's evident that more education is needed to support clinicians as states begin legislating wider access of naloxone for bystanders of overdoses."