July 1, 2015
Why Clinicians Are Hesitant to Prescribe Naloxone to
Opioid Users

Denver—Why don’t more patients on opioids also have a prescription for a potentially life-saving medication that counteracts the effects of a drug overdose?

A study recently published in the Journal of General Internal Medicine suggests a variety of factors affect clinician willingness to prescribe naloxone, including questions about risk and reluctance to offend patients. The findings were based on 10 focus groups conducted with 56 clinicians between August 2013 and August 2014 by researchers from Kaiser Permanente, Denver Health Medical Center and the University of Colorado School of Medicine.

Background in the article points out that the number of fatal overdoses from opioid medications has quadrupled in the U.S. since 1999. Naloxone, which reverses depressed respiration caused by opioids, is intended to be administered by family members or other bystanders in the event of an overdose.

Laws in 30 states and the District of Columbia allow clinicians to prescribe naloxone or have pilot programs in place to distribute the medication.

The focus groups obtained feedback on attitudes about prescribing naloxone to patients also taking opioids, including that clinicians commonly believe that naloxone can effectively prevent overdose deaths, while a prescription might increase patient understanding of the risks associated with opioid use.

Yet, the researchers determined that only three of the 37 clinicians with prescribing authority had prescribed naloxone. The reasons included:

• Logistical challenges, such as time restraints within clinical appointments;
• Hesitancy to prescribe naloxone because of concerns that patients would be offended;
• Concerns that bystanders who would actually deliver naloxone receive proper and confidential training, and are able to recognize the signs of an overdose; and.
• Worries about possible adverse effects of the drug in widespread use.

“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.”

Binswanger called for further research to address the questions raised by clinicians in the study focus groups, especially how increased naloxone prescribing affects patient satisfaction, opioid use and patient safety.
U.S. Pharmacist Social Connect