Skip to main content

Advertisement

SpringerLink
Log in

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a “take-home” dose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zule W. Risk and reciprocity: HIV and the injection drug user. J Psychoact Drugs. 1992;24:242–249.

    Google Scholar 

  2. Sporer KA. Strategies for preventing heroin overdose. BMJ. 2003;326(7386):442–444.

    Article  PubMed  Google Scholar 

  3. Darke S, Zador D. Fatal heroin ‘overdose’: a review. Addiction. 1996;91(12):1765–1772.

    Article  PubMed  CAS  Google Scholar 

  4. Warner-Smith M, Darke S, Lynskey M, Hall W. Heroin overdose: causes and consequences. Addiction. 2001;96(8):1113–1125.

    Article  PubMed  CAS  Google Scholar 

  5. Warner-Smith M, Darke S, Day C. Morbidity associated with non-fatal heroin overdose. Addiction. 2002;97(8):963–967.

    Article  PubMed  Google Scholar 

  6. Hall W, Darke S. Trends in opiate overdose deaths in Australia 1979–1995. Drug Alcohol Depend. 1998;52(1):71–77.

    Article  PubMed  CAS  Google Scholar 

  7. Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. Prevalence and correlates of non-fatal overdose. Addiction. 1996;91(3):405–411.

    Article  PubMed  CAS  Google Scholar 

  8. Burris S, Edlin B, Norland J. Legal aspects of providing naloxone to heroin users in the United States. Int J Drug Policy. 2001;12:237–248.

    Article  Google Scholar 

  9. Dettmer K, Saunders B, Strang J. Take home naloxone and the prevention of deaths from opiate overdose: two pilot schemes. BMJ. 2001;322:895–896.

    Article  PubMed  CAS  Google Scholar 

  10. Seal KH, Downing M, Kral AH, et al. Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay area. J Urban Health. June 1. 2003;80(2):291–301.

    PubMed  Google Scholar 

  11. McGregor C, Darke S, Ali R, Christie P. Experience of non-fatal overdose among heroin users in Adelaide, Australia: circumstances and risk perceptions. Addiction. 1998;93(5):701–711.

    Article  PubMed  CAS  Google Scholar 

  12. Darke S, Hall W. Heroin overdose: research and evidence-based intervention. J Urban Health. 2003;80(2):189–200.

    PubMed  Google Scholar 

  13. Dietze P. Intranasal naloxone is an effective first line treatment for suspected opioid overdose in the prehospital setting. Paper presented at: 15th International Conference on the Reduction of Drug Related Harm; April 24, 2004; Melbourne, Australia.

  14. Food, Drug, and Cosmetic Act Sec. 503(b)(1). U.S.C. Vol 21; 1999.

  15. Centers for Disease Control and P. Heroin overdose deaths—Multnomah County, Oregon, 1993–1999. MMWR — Morbidity & Mortality Weekly Report. 2000;49(28):633–636.

  16. Strang J, Darke S, Hall W, Farrell M, Ali R. Heroin overdose: the case for take-home naloxone. BMJ. 1996;312(7044):1435–1436.

    PubMed  CAS  Google Scholar 

  17. Strang J, Powis B, Best D, et al. Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability. Addiction. 1999;94(2):199–204.

    Article  PubMed  CAS  Google Scholar 

  18. Sporer KA. Acute heroin overdose. Ann Intern Med. 1999;130(7):584–590.

    PubMed  CAS  Google Scholar 

  19. Vilke GM, Buchanan J, Dunford JV, Chan TC. Are heroin overdose deaths related to patient release after pre-hospital treatment with naloxone? Prehosp Emerg Care. 1999;3(3):183–186.

    Article  PubMed  CAS  Google Scholar 

  20. Bigg D. Opiate Overdose Prevention/Intervention Using Take-Home Naloxone. Paper presented at: 131st Annual Meeting of the American Public Health Association; November 18, 2003; San Francisco, California.

  21. Fiuty P. Naloxone Prescription to IDUs in New Mexico. Paper presented at: 131st Annual Meeting of the American Public Health Association; November 18, 2003; San Francisco, California.

  22. MacGillis A. City Overdose Deaths Fell by 12% Last Year: Ilicit Drug Toll of 261 in ’04 Was Lowest in 5 Years. Baltimore Sun. March 28, 2005;A:1.

  23. Seal KH, Thawley R, Gee L, et al. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. J Urban Health. 2005;82(2):303–311.

    PubMed  Google Scholar 

  24. Sherman SG, Kral AH, Lorvick JA. Epidemiology of opiate overdose and response: a review of overdose prevention naloxone prescription interventions. Paper presented at: New York State Department of Health; April 18, 2005; New York City, New York.

  25. Campana M. Overdose Mortality and Naloxone Distribution in Italy. Paper presented at: Preventing Heroin Overdose: Pragmatic Approaches; Jan. 13–14, 2000; Seattle, WA.

  26. Finkelstein R, Ramos SE. Manual for Primary Care Providers: Effectively Caring for Active Substance Users. New York, NY: New York Academy of Medicine; 2003.

    Google Scholar 

  27. National Center on Addiction and Substance Abuse. Missed opportunity: National survey of primary care physicians and patients on substance abuse. New York, NY: Columbia University; 2000.

    Google Scholar 

  28. Ding L, Landon BE, Wilson IB, Wong MD, Shapiro MF, Cleary PD. Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users. Arch Intern Med. 2005;165:618–623.

    Article  PubMed  Google Scholar 

  29. Gastfriend DR. Physician substance abuse and recovery: what does it mean for physicians—and everyone else? JAMA. 2005;293(12):1513–1515.

    Article  PubMed  CAS  Google Scholar 

  30. Heller D, McCoy K, Cunningham C. An invisible barrier to integrating HIV primary care with harm reduction services: philosophical clashes between the harm reduction and medical models. Public Health Rep. 2004;119(1):32–39.

    PubMed  Google Scholar 

  31. Swenson-Britt E, Carrougher G, Martin BW, Brackley M. Project Hope: changing care delivery for the substance abuse patient. Clin Nurse Spec. 2000;14(2):92–100.

    Article  PubMed  CAS  Google Scholar 

  32. Rich JD, McKenzie M, Macalino GE, et al. A syringe prescription program to prevent infectious disease and improve health of injection drug users. J Urban Health. 2004;81(1):122–134.

    PubMed  Google Scholar 

  33. Coffin PO, Blaney S, Fuller C, Vadnai L, Miller S, Vlahov D. Support for buprenorphine and methadone prescription to heroin-dependent patients among New York City physicians. Am J Drug Alcohol Abuse. 2006;32(1):1–6.

    Article  PubMed  Google Scholar 

  34. National Center for Health Statistics. Health, United States, 2003, with Chartbook on Trends in the Health of Americans. Hyattsville, Maryland: U.S. Department of Health and Human Services; 2003.

  35. Tobin KE, Gaasch WR, Clarke C, MacKenzie E, Latkin CA. Attitudes of emergency medical service providers toward naloxone distribution programs. J Urban Health. 2005;82(2):296–302.

    PubMed  Google Scholar 

  36. O’Connor PG, Selwyn PA, Schottenfeld RS. Medical progress: medical care for injection-drug users with human immunodeficiency virus infection. New Engl J Med. 1994;331:450–459.

    Article  PubMed  CAS  Google Scholar 

  37. Wartenberg AA. ‘Into whatever houses I enter’. HIV and injecting drug use. JAMA. 1994;271(2):151–152.

    Article  PubMed  CAS  Google Scholar 

  38. Weinrich M, Stuart M. Provision of methadone treatment in primary care medical practices: review of the Scottish experience and implications for U.S. Policy. JAMA. 2000;283:1343–1348.

    Article  PubMed  CAS  Google Scholar 

  39. Kendal EM. Effects of Attitudes on Delivery of Healthcare. The Community Health Nurse and Alcohol Problems. Rockford, Maryland: U.S. Department of Health; 1978.

    Google Scholar 

  40. Leshner AI. Science-based views of drug addiction and its treatment. JAMA. 1999;282(14):1314–1316.

    Article  PubMed  CAS  Google Scholar 

  41. Coffin PO, Fuller C, Vadnai L, Blaney S, Galea S, Vlahov D. Preliminary evidence of health care provider support for naloxone prescription as overdose fatality prevention strategy in New York City. J Urban Health. 2003;80(2):288–290.

    PubMed  Google Scholar 

  42. Limbert C, Lamb R. Doctors’ use of clinical guidelines: two applications of the Theory of Planned Behaviour. Psychol Health Med. 2002;7(3):301–310.

    Article  Google Scholar 

  43. Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA. A survey of pessary use by members of the American Urogynecologic Society. Obstet Gynecol. 2000;95(6 Pt 1):931–935.

    Article  PubMed  CAS  Google Scholar 

  44. Urban N, Anderson GL, Tseng A. Effects on response rates and costs of stamps vs business reply in a mail survey of physicians. J Clin Epidemiol. 1993;46(5):455–459.

    Article  PubMed  CAS  Google Scholar 

  45. Wolfe JM, Lein DY, Lenkoski K, Smithline HA. Analgesic administration to patients with an acute abdomen: a survey of emergency medicine physicians. Am J Emerg Med. 2000;18(3):250–253.

    Article  PubMed  CAS  Google Scholar 

  46. Gerbert B, Maguire BT, Bleecker T, Coates TJ, McPhee SJ. Primary care physicians and AIDS. Attitudinal and structural barriers to care. JAMA. 1991;266(20):2837–2842.

    Article  PubMed  CAS  Google Scholar 

  47. Ritson EB. Alcohol, drugs and stigma. Int J Clin Pract. 1999;53:549–551.

    PubMed  CAS  Google Scholar 

  48. Coffin PO, Linas BP, Factor SH, Vlahov D. New York City pharmacists’ attitudes toward sale of needles/syringes to injection drug users before implementation of law expanding syringe access. J Urban Health. 2000;77(4):781–793.

    Article  PubMed  CAS  Google Scholar 

  49. Rich JD, Whitlock TL, Towe CW, et al. Prescribing syringes to prevent HIV: a survey of infectious disease and addiction medicine physicians in Rhode Island. Subst Use Misuse. 2001;36(5):535–550.

    Article  PubMed  CAS  Google Scholar 

  50. Hilton BA, Thompson R, Moore-Dempsey L, Janzen RG. Harm reduction theories and strategies for control of human immunodeficiency virus: a review of the literature. J Adv Nurs. 2001;33(3):357–370.

    Article  PubMed  CAS  Google Scholar 

  51. Wodak A, Cooney A. Effectiveness of sterile needle and syringe programmes. Int J Drug Policy. 2005;16(Supp 1):S31–44.

    Article  Google Scholar 

  52. Klausner JD, Chaw JK. Patient-delivered therapy for chlamydia: putting research into practice. Sex Transm Dis. 2003;30(6):509–511.

    Article  PubMed  Google Scholar 

  53. New York State Assembly. An act to amend the public health law, in relation to opioid overdose prevention. McKinney’s Public Health Law. 2005–2006 Regular Sessions ed; 2006.

  54. An Act Relating To Drugs; Authorizing And Releasing From Liability Persons Who Administer Opioid Antagonists; Releasing From Liability Licensed Health Care Professionals; Declaring An Emergency. New Mexico Statutes Annotated. Vol §§ 24-31-1 & -2; 2006.

Download references

Acknowledgements

This work was supported by a grant from the Substance Abuse Policy Research Program of the Robert Wood Johnson Foundation. The views expressed are those of the authors and do not imply endorsement by the Program or the Robert Wood Johnson Foundation. Authors thank the American Medical Association for its assistance in this project and report no financial or other conflict of interest associated with any product or service described in this article. Beth Schwartzapfel provided valuable research and editing support.

Author information

Authors and Affiliations

  1. Temple University Beasley School of Law, Philadelphia, PA, USA

    Leo Beletsky (MPH, Senior Associate) & Scott Burris

  2. Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA

    Robin Ruthazer

  3. Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts New England Medical Center, Boston, MA, USA

    Grace E. Macalino

  4. Brown University and The Miriam Hospital, Providence, RI, USA

    Josiah D. Rich

  5. American Medical Association, Chicago, IL, USA

    Litjen Tan

  6. Temple University Beasley School of Law, 1719 N. Broad St., Philadelphia, PA, 19122, USA

    Leo Beletsky (MPH, Senior Associate)

Authors
  1. Leo Beletsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robin Ruthazer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grace E. Macalino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josiah D. Rich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Litjen Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Scott Burris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leo Beletsky.

Additional information

Beletsky and Burris are with the Temple University Beasley School of Law, Philadelphia, PA, USA; Ruthazer is with the Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA, USA; Macalino is with the Tufts University School of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts New England Medical Center, Boston, MA, USA; Rich is with the Brown University and The Miriam Hospital, Providence, RI, USA; Tan is with the American Medical Association, Chicago, IL, USA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beletsky, L., Ruthazer, R., Macalino, G.E. et al. Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities. J Urban Health 84, 126–136 (2007). https://doi.org/10.1007/s11524-006-9120-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-006-9120-z

Keywords

Search

Navigation