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

Journal of Urban Health, Vol. 84, No. 1, pp. 126-137, 2006

24 Pages Posted: 22 Dec 2006 Last revised: 12 Mar 2012

Leo Beletsky

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences

Robin Ruthazer

Tufts New England Medical Center (NEMC)

Grace Macalino

Tufts New England Medical Centre (NEMC)

Josiah D. Rich

Brown University - School of Medicine

Litjen Tan

American Medical Association

Scott Burris

Center for Public Health Law Research, Temple University - James E. Beasley School of Law

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 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. Food and Drug Administration re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be urgently explored.

Keywords: Heroin, Injection drug use, Overdose, Prevention, Naloxone, Physician Behavior, Physician Education, Evidence-Based Practice

Suggested Citation

Beletsky, Leo and Ruthazer, Robin and Macalino, Grace and Rich, Josiah D. and Tan, Litjen and Burris, Scott, Physicians' Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities. Journal of Urban Health, Vol. 84, No. 1, pp. 126-137, 2006. Available at SSRN: https://ssrn.com/abstract=952469

Leo Beletsky (Contact Author)

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences ( email )

416 Huntington Avenue
Boston, MA 02115
United States
617-373-5540 (Phone)

Robin Ruthazer

Tufts New England Medical Center (NEMC) ( email )

750 Washington Street #63
Boston, MA 02111
United States

Grace Macalino

Tufts New England Medical Centre (NEMC) ( email )

750 Washington Street #63
Boston, MA 02111

Josiah D. Rich

Brown University - School of Medicine ( email )

Box G-MH
Providence, RI 02912
United States

Litjen Tan

American Medical Association ( email )

515 North State St.
Chicago, IL 60610
United States

Scott C. Burris

Center for Public Health Law Research, Temple University - James E. Beasley School of Law ( email )

1719 N. Broad Street
Philadelphia, PA 19122
United States
215-204-6576 (Phone)
215-204-1185 (Fax)

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