Barriers remain in patients' acceptance of naloxone use in primary care
Patients would like more thorough conversations with their primary care physician over the use of naloxone.
Although naloxone is acceptable to patients on high-dose chronic opioid therapy, concerns about its use could be addressed through better communication with their primary care provider, according to a study in the Journal of Generic Internal Medicine.
Shane R Mueller, MSW, from the Institute for Health Research, Kaiser Permanente in Denver, and colleagues interviewed 186 patients aged 21 to 65 years who have received 3 or more opioid prescriptions within a 90-day period. The participants were asked to characterize their prior education about the risks of opioid medications, concerns about overdose from their medications, knowledge of and experience with overdose, and knowledge about naloxone. The patients were also asked to reflect on their communication with and trust in their healthcare providers, and how they would want to receive information about naloxone and overdose.
The participants identified 6 barriers that reduced enthusiasm for naloxone: 1) limited prior education about opioid risks; 2) limited knowledge about naloxone; 3) low perception of overdose risk; 4) fear of exacerbating providers' concerns about opioid misuse; 5) fear of consequences and loss of pain treatment if naloxone is used; and 6) pragmatic barriers including cost of naloxone, possible adverse events and drug interactions, and how long naloxone would last before expiration.
Potential facilitators to patient acceptance of naloxone included: 1) recognition of the utility of naloxone to prevent overdose death; 2) providers who engage in empowering and non-judgmental communication practices; 3) framing discussions about naloxone to address patients' fears; and 4) training and education for patients and caregivers who might administer naloxone.
“Overall, naloxone was acceptable to patients on high-dose chronic opioid therapy, said the researchers. “Future research should evaluate whether the universal prescribing of naloxone would result of greater acceptance of pain patients to ultimately reduce patient mortality.”
- Mueller SR, Koester S, Glanz JM, Gardner EM, Binswagner IA. Attitudes toward naloxone prescribing in clinical settings: a qualitative study of patients prescribed high dose opioids for chronic non-cancer pain. J Gen Intern Med. 31 Oct 2016. DOI: 10.1007/s11606-016-3895-8