Attitudes Toward Naloxone Prescribing in Clinical Settings: A Qualitative Study of Patients Prescribed High Dose Opioids for Chronic Non-Cancer Pain

Abstract

Background: Over the last 2 decades, medical providers have increasingly prescribed pharmaceutical opioids for chronic non-cancer pain, while opioid overdose death rates have quadrupled. Naloxone, an opioid antagonist, can be prescribed to patients with chronic pain to reverse an opioid overdose, yet little is known about how patients perceive this emerging practice.

Objective: This study assessed the knowledge and attitudes toward naloxone prescribing among non-cancer patients prescribed opioids in primary care.

Design: Qualitative study design using semi-structured interviews.

Participants: Adults (N = 24) prescribed high-dose (≥100 morphine mg equivalent daily dose) chronic opioid therapy in eight primary care internal medicine, family medicine and HIV practices in three large Colorado health systems.

Approach: Inductive and deductive methods were used to analyze interview transcripts.

Key results: Themes emerged related to knowledge of and benefits, barriers and facilitators to naloxone in primary care. Patients reported receiving limited education about opioid medication risks from providers and limited knowledge of naloxone. When provided with a description of naloxone, patients recognized its ability to reverse overdoses. In addition to pragmatic barriers, such as medication cost, barriers to naloxone acceptance included the perception that overdose risk stems from medication misuse and that providers might infer that they were misusing their opioid medication if they accepted a naloxone prescription, prompting an opioid taper. Facilitators to the acceptance of naloxone included medical providers' using empowering, non-judgmental communication practices, framing naloxone for use in "worst case scenarios" and providing education and training about opioids and naloxone.

Conclusions: While patients recognized the utility of naloxone prescribing, we identified important barriers to patient acceptance of naloxone prescribing. To improve the naloxone prescribing acceptability in primary care practice, medical providers and health systems may need to enhance patient education, employ empowering, non-judgmental communication styles and adequately frame discussions about naloxone to address patients' fears.

Keywords: naloxone; opioids; overdose; primary care; qualitative research.

Conflict of interest statement

Funders

Research reported in this publication was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number R34DA035952. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Prior Presentations

Preliminary data from earlier portions of this study were presented at the 38th Annual SGIM meeting in Toronto, Canada, and the 77th Annual CPDD meeting in Phoenix, AZ.

Conflict of Interest

The authors declare that they do not have a conflict of interest.