Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

Abstract

Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a Btake-homed ose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff

“…Surveys in 2002-2003 demonstrated that few medical providers were knowledgeable about prescribing naloxone to prevent overdose, were willing to prescribe naloxone, or supported naloxone distribution. [20][21][22] While these surveys were conducted early in the overdose epidemic and did not focus on patients prescribed opioids, their findings suggest that there may be considerable barriers to naloxone prescribing in primary care. To better understand these barriers, we conducted a qualitative study to assess clinical staff's knowledge, attitudes and beliefs about overdose education and naloxone prescribing.…”

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

“…Even though an early survey of drug users had found that THN was unlikely to lead to increased heroin consumption , a common concern among providers was potential promotion of drug use (Ashworth, 2006;Tobin et al, 2005). Negative attitudes were revealed in surveys of Baltimore-based emergency service providers (Tobin et al, 2005) and physicians throughout the US who were likely involved in treatment of opioid users (Beletsky et al, 2007): most believed THN would not reduce drug-related deaths and reported they would never consider prescribing naloxone. A notable exception was a postal survey of New York-based clinicians of whom over a third were willing to prescribe naloxone (Coffin et al, 2003).…”

Assessing knowledge and attitudes towards addictions in medical residents of a general hospital

“…By contrast, another study found mixed results when comparing medical students with their age mates in the general population (Flaherty & Richman, 1993). The prevalence of SUDs among doctors and medical students is near to 14%, being specialities such as anaesthesiology, psychiatry and emergency medicine the most related with substance use problems (Beletsky et al, 2007;Choi, Tolova, Socha, & Samenow, 2013;Cottler et al, 2013;Rose, Campbell, & Skipper, 2014). As denial is a common feature among people with substance use problems, it might be expected that the exposure of medical residents to substance use (both regarding themselves and their circle of friends or family), would minimize their ability to self-detect them and seek help (Miller, Sheppard, Colenda, & Magen, 2001).…”

“…Research has linked attitudes and level of addiction treatment training (specifically harm-reduction approaches), to therapeutic outcomes (Beletsky et al, 2007;Deren, Kang, Mino, & Seewald, 2011;Gerlach & Caplehorn, 1999;Goddard, 2003). This points to the need of making an integrated change in medical internship programmes (Ding et al, 2005).…”