Primary Care Patient Experience with Naloxone Prescription

Notwithstanding a paucity of data, prescription of the opioid antagonist naloxone to patients prescribed opioids is increasingly recommended in opioid stewardship guidelines. The aim of this study was to evaluate chronic pain patients' attitudes toward being offered a naloxone prescription and their experience with naloxone.

We interviewed 60 patients who received naloxone prescriptions across 6 safety-net primary care clinics (10 patients per clinic) from October 2013 to October 2015. We used a standardized questionnaire to collect information on substance use, perception of personal overdose risk, history of overdose, and experiences with naloxone prescription, including initial reaction, barriers to filling the prescription, storage and use of naloxone, associated behavioral changes, and opinions about future prescribing.

Respondents were demographically similar to all clinic patients receiving opioid prescriptions. Ninety percent had never previously received a naloxone prescription, 82% successfully filled a prescription for naloxone, and 97% believed that patients prescribed opioids for pain should be offered naloxone. Most patients had a positive (57%) or neutral (22%) response to being offered naloxone, and 37% reported beneficial behavior changes after receiving the prescription; there were no harmful behavior changes reported. Although 37% had personally experienced an opioid-poisoning event (17% of which were described as bad reactions but consistent with an overdose) and 5% reported that the prescribed naloxone had been used on them, 77% estimated their risk of overdose as low.

Primary care patients on opioids reported that receiving a prescription for naloxone was acceptable, the prescription reached patients who had not had access to naloxone, and having naloxone may be associated with beneficial changes in opioid use behaviors. Patients prescribed opioids may not interpret the terminology describing overdose to imply unintentional opioid poisoning.