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Primary care patients on opioids willing to consider naloxone prescription

Patients in primary care who are taking opioids reported that they would consider a prescription for naloxone, a medication that can stop or reverse the effects of an opioid overdose, according to data published in the Annals of Family Medicine.

Naloxone has emerged has an important opion in the effort against opioid overdose, and the larger fight against what federal health officials have called an opioid epidemic. Among their conclusions, the researchers added that having naloxone may be associated with beneficial changes in patients’ opioid use behaviors.

“Drug overdose, driven by opioids, is the leading cause of accidental death in the United States, accounting for more than 47,000 deaths in 2012,” Emily Behar, MS, of the San Francisco Department of Public Health, and colleagues wrote. “Distribution of the opioid antagonist naloxone has been associated with a reduction in opioid overdose mortality and is recommended for patients prescribed opioids with such risk factors as receipt of more than 50 mg morphine equivalents, concurrent benzodiazepine use or substance abuse disorder…. Clinicians have noted several potential barriers to prescribing naloxone, including lack of training and fear of offending patients; however, there have been no evaluations of patients’ experiences of receiving naloxone through primary care.”

To analyze the attitudes of patients with chronic pain toward being offered naloxone by their PCP, and their experience with the medication, the researchers interviewed 60 patients from October 2013 to October 2015. The patients had been part of a naloxone co-prescribing program, and had been receiving treatment at a “safety net” clinic, serving only the publically insured or uninsured.

The patients had received naloxone prescriptions and then later answered a 49-item, standardized questionnaire, providing information on substance abuse, perception of personal overdose risk, history of overdose and experiences with naloxone, including initial reaction, barriers to filling the prescription, storage and use, associated behavior changes and views on future prescribing.

According to the researchers, 90% had never been provided with a naloxone prescription, and 82% were able to successfully fill their prescription once they received it. In addition, 97% believed that patients who are prescribed opioids for pain should be offered naloxone. When offered the opioid antagonist by their PCP, 57% of patients said they had a positive reaction, while 22% said they were neutral. After receiving naloxone, 37% reported beneficial behavioral changes. There were no reported negative behavioral changes. Despite the fact that 37% had reported a previous opioid-poisoning, and that 5% said they had previously required naloxone treatment, 77% of patients estimated their own risk for overdose as “low.”

“Most patients had neither heard of nor received naloxone before this intervention, suggesting that primary care prescribing reaches a population distinct from community distribution, even in a city with robust naloxone programming…,” Behar and colleagues wrote. “Prescribing naloxone appears to be acceptable among safety-net primary care patients prescribed long-term opioids, primary care clinicians may reach a population not served by community distribution, and prescriptions for naloxone may help reduce the morbidity and mortality of opioid poisoning.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.