Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision

Abstract

BackgroundMore than 200 opiate overdose deaths occur annually in Ireland. Overdose prevention and management, including naloxone prescription, should be a priority for healthcare services. Naloxone is an effective overdose treatment and is now being considered for wider lay use.Aim To establish GPs’ views and experiences of opiate addiction, overdose care, and naloxone provision.Design and setting An anonymous postal survey to GPs affiliated with the Department of Academic General Practice, University College Dublin, Ireland.MethodA total of 714 GPs were invited to complete an anonymous postal survey. Results were compared with a parallel GP trainee survey.ResultsA total of 448/714 (62.7%) GPs responded. Approximately one-third of GPs were based in urban, rural, and mixed areas. Over 75% of GPs who responded had patients who used illicit opiates, and 25% prescribed methadone. Two-thirds of GPs were in favour of increased naloxone availability in the community; almost one-third would take part in such a scheme. A higher proportion of GP trainees had used naloxone to treat opiate overdose than qualified GPs. In addition, a higher proportion of GP trainees were willing to be involved in naloxone distribution than qualified GPs. Intranasal naloxone was much preferred to single (P<0.001) or multiple dose (P<0.001) intramuscular naloxone. Few GPs objected to wider naloxone availability, with 66.1% (n = 292) being in favour.ConclusionGPs report extensive contact with people who have opiate use disorders but provide limited opiate agonist treatment. They support wider availability of naloxone and would participate in its expansion. Development and evaluation of an implementation strategy to support GP-based distribution is urgently needed.

Opiate use disorders and overdose: Medical students' experiences, satisfaction with learning, and attitudes toward community naloxone provision

“…The development of the study instrument was informed by a prior epidemiological study of opioid overdose in Dublin, by an evaluation of an educational intervention for overdose prevention and naloxone distribution among GP trainees (28,29) and by a modified version of the instrument used previously by this group to examine general practitioners' (GP) and GP trainees' experiences and attitudes toward opioid use disorder and overdose (8,9). The survey consisted of 11 questions on demographics, experience of and attitudes toward opioid use disorder and naloxone distribution, and perceived competence to recognise, assess and manage opioid use disorder, using a five point scale (1 = strongly disagree, 5 = strongly agree).…”

“…However, its administration in Ireland has traditionally been restricted to doctors, nurses and paramedics (6). A 2016 Naloxone Demonstration Project in Ireland has recommended wider availability of naloxone in the community (7), and our previous research suggests support among GPs (8) and GP Trainees (9) in Ireland for its wider availability .…”

National Institute on Drug Abuse International Program

“…However, GPs do not generally consider themselves as first responders in overdose cases and were not included in a recent demonstration project of expanding use of naloxone for overdose beyond use by paramedics. The study found that one third of GPs practicing in Ireland and two thirds of GP trainees would be willing to take part in a program of distribution [16,17]. …”

Opioid analgesic dependence: where do we go from here?

“…11 A related article in this issue of BJGP is encouraging and shows that future generations of GPs are more open to issues around safer opioid prescribing. 12…”