title: 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.
  
  
  METHODS
  Qualitative study design using semi-structured interviews.
  
  
  METHODS
  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.
  
  
  METHODS
  Inductive and deductive methods were used to analyze interview transcripts.
  
  
  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.
authors: Institute for Health Research, Kaiser Permanente Colorado, 10065 E. Harvard Ave., Suite 300, Denver, CO, 80231, USA. Shane.Mueller@kp.org.|Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA. Shane.Mueller@kp.org.
authors: Shane R
authors: SR
authors: Mueller
authors: Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA.|Department of Anthropology, University of Colorado Denver, Denver, CO, USA.
authors: Stephen
authors: S
authors: Koester
authors: Institute for Health Research, Kaiser Permanente Colorado, 10065 E. Harvard Ave., Suite 300, Denver, CO, 80231, USA.|Department of Epidemiology, Colorado School of Public Health, Denver, CO, USA.
authors: Jason M
authors: JM
authors: Glanz
authors: Denver Health and Hospital Authority, Denver, CO, USA.
authors: Edward M
authors: EM
authors: Gardner
authors: Institute for Health Research, Kaiser Permanente Colorado, 10065 E. Harvard Ave., Suite 300, Denver, CO, 80231, USA.|Division of General Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA.
authors: Ingrid A
authors: IA
authors: Binswanger
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000506:poisoning; D001291:Attitude of Health Personnel; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010353:Patient Education as Topic; D011320:Primary Health Care; D036301:Qualitative Research; D012306:Risk
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone
keywords: naloxone; opioids; overdose; primary care; qualitative research