Physician and Pharmacist: Attitudes, Facilitators, and Barriers to Prescribing Naloxone for Home Rescue

Abstract

Background and ObjectivesWe implemented a naloxone education and distribution program in our academic health system. Despite the program, naloxone prescribing was not fully realized. This study aimed to identify the barriers to prescribing.MethodsWe conducted a prospective, cross‐sectional, mixed‐methods study of naloxone prescribers. Participants completed a questionnaire regarding their prescribing practices, attitudes, facilitators, and barriers to prescribing naloxone. Participants were then invited for an interview to further explore these topics and elicit more in‐depth explanations.ResultsSixty‐four physicians and eight pharmacists completed the questionnaire (n = 72). The most commonly reported barrier to prescribing naloxone was time constraints (33%). During the interviews, 14 subthemes emerged within four themes: provider competency, provider beliefs, health care system, and patient factors/social climate.DiscussionPrescribers identified barriers to naloxone prescribing despite implementation of an institutional overdose education and naloxone distribution (OEND) program. The results were similar to those previously reported prior to initiation of such programs.ConclusionIn this study, we examined barriers and facilitators to naloxone prescribing. Although previous studies have shown that health care providers endorsed similar barriers, our study indicates that some of those barriers persist despite a concerted effort to educate and promote prescribing via an OEND. While our study is limited by a small, selective sample size the results indicate that improvements to our OEND program are warranted.Scientific SignificanceOur study addressed an unexplored area of OEND research and may inform future program development. (Am J Addict 2019;00:00–00)

Individual and Community Factors Associated with Naloxone Co-prescribing Among Long-term Opioid Patients: a Retrospective Analysis

“…A range of approaches are needed, including increasing support and expansion of opioid education and naloxone distribution programs, 26 enhancing pharmacist and prescriber education about naloxone, identifying and educating patients at elevated overdose risk, and addressing pharmacists' and providers' perceived barriers to distributing and prescribing naloxone. [27][28][29] Consistent with other studies, 15,21 we found higher rates of naloxone co-prescribing among patients prescribed long-term opioid therapy by pain/anesthesia doctors and nurse practitioners/physician assistants as well as higher rates in metropolitan counties. Interestingly, we also found naloxone co-prescribing rates followed an inverse U-pattern with respect to age, peaking with the 46-55 age group.…”

Perspectives of Stakeholders of Equitable Access to Community Naloxone Programs: A Literature Review

“…Stigma was found to be a potential barrier to participation in naloxone programs [ 28 , 33 , 36 , 41 , 46 , 50 - 51 , 54 - 55 , 67 , 72 , 74 ]. When people who use opioids had not previously experienced an overdose, there was often denial that they would ever be at risk of overdosing and requiring naloxone treatment [ 67 ].…”

“…In addition, healthcare providers perceived that clients limited their interactions due to their fear of discrimination when accessing services [ 46 , 50 , 73 ]. Reviewing this literature revealed that there is a misconception among healthcare providers that distributing naloxone may promote continued or riskier opioid use [ 30 , 32 - 33 , 42 , 45 , 49 , 51 , 54 , 60 - 61 , 63 , 66 , 68 - 69 , 71 ]. Alternatively, healthcare providers perceived that naloxone distribution could pose a safety concern to the general public as a result of the potential aggressive behaviors associated with the naloxone recipient’s withdrawal side effects [ 24 , 33 ].…”

“…The findings indicated that barriers to implementation included the lack of allied health support for client education; lack of time devoted to educating patients; and inadequate follow-up with the recipient of the naloxone kit. Lack of knowledge about naloxone programs and discomfort in distributing naloxone kits were also seen from programs that were established in different jurisdictions [ 33 , 54 , 57 ]. A perceived lack of time for adequate client education and training was frequently mentioned as a barrier [ 23 - 24 , 30 , 41 - 42 , 51 , 56 , 58 , 60 , 64 , 68 ]; this could be addressed by the adoption of mitigating strategies.…”

“…Lack of information surrounding the legal liability of those administrating naloxone to someone who has overdosed was also found to be a major barrier to utilization [24,33,43]. Some studies highlighted the need for public education by healthcare providers to raise awareness of misinformation related to opioids and naloxone with the aim of reducing stigma and discrimination [28,40,54,67,[74][75].…”