Patient Insights to Improve Naloxone Access and Decision Support

Increased access to naloxone has contributed to reductions in opioid-related overdose. However, many individuals prescribed naloxone do not fill their prescription. Better understanding modifiable patient-level barriers to naloxone receipt may inform health system-level implementation strategies that improve naloxone availability.

A quality improvement survey was emailed to adult members of Kaiser Permanente Northwest with a valid email address who had an order for naloxone between September 15, 2023 and September 15, 2024 that appeared unfilled in pharmacy records. Using χ² tests for categorical variables and analysis of variance for continuous variables, the authors compared individuals who filled vs did not fill a naloxone prescription.

A total of 481 responses were received (19% response rate). More than half (57.5%) of respondents reported not obtaining naloxone at a pharmacy or other community resource. Primary reasons included: perceived lack of need (55.3%), unawareness of practitioner recommendation (14.9%), uncertainty about its purpose (13.1%), cost concerns (7.3%), and unfamiliarity with naloxone (4.4%). Fewer than 10 respondents cited logistical barriers.

Results from this quality improvement survey are consistent with previous studies of barriers to naloxone use. Among patients who did not fill a prescription for naloxone, many did not assess their personal risk of overdose to be high, and some resented a perceived implication that they might be abusing opioids. Others were unaware that a naloxone prescription was written until notified by a pharmacist. Cost and logistical barriers were less common concerns, each for less than 10% of those not filling a prescription.

Clear, nonjudgmental communication about the risk for opioid-related overdose, even among people using their opioids appropriately, and education about the purpose of naloxone may improve access.