Improved Emergency Medicine Physician Attitudes Towards Individuals with Opioid Use Disorder Following Naloxone Kit Training

Appel, Giselle; Avery, Joseph J.; Ho, Kaylee; Livshits, Zhanna; Rao, Rama; Avery, Jonathan

doi:10.1016/j.ajem.2019.11.019

Cited by 10 publications

(14 citation statements)

References 26 publications

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“…10 Opioid awareness training has been developed for prescription providers, patients who may receive opioids, and/or emergency responders and others who could reverse an overdose with naloxone. [11][12][13][14] The National Safety Council reports that 26 percent of employers provide educational programs on prescription opioids to at least some of their employees. 15 Training content generally focuses on overdose prevention and awareness of the harms of stigma related to substance use disorder, rather than prevention of exposure to risk factors leading to opioid use.…”

Section: Introductionmentioning

confidence: 99%

Promoting Opioid Awareness Through a Union-Based Peer Training Model

et al. 2021

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Work factors, including physical job demands, appear to be risk factors for opioid overdoses. We collaborated with unions representing workers in high-risk occupations and offered resources to develop tailored educational interventions for their members. An ironworkers’ local, a statewide nurses’ union, and a Teamsters local union participated, at levels higher than we had anticipated. The three unions trained 285 workers, including apprentices, stewards, and those nearing retirement. Short surveys assessed pre- and post-training knowledge, attitudes, confidence in helping others, and related domains. Seventy percent of respondents reported heavy or very heavy physical demands at work, and one-half had experienced work-related pain. After training, participants reported more knowledge about opioids, less concern about stigma related to help-seeking, and more ability to provide help to a co-worker struggling with opioids. Peers with recovery experience provided a unique contribution to training. Tailored job-specific and peer-delivered educational interventions may be able to reduce the potential impact of opioids on working people.

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Section: Introductionmentioning

confidence: 99%

Promoting Opioid Awareness Through a Union-Based Peer Training Model

et al. 2021

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“…Although this is one of the first studies to document bystander attitudes toward naloxone, prior research has documented attitudes and misconceptions about naloxone among pharmacists [ 21 , 28 – 31 , 33 , 34 , 36 , 39 , 74 – 78 ] and the general public [ 49 , 51 , 79 ]. Additionally, some medical providers are reluctant to prescribe naloxone based on the belief that treating SUD and overdose prevention are mutually exclusive [ 37 , 40 ]. While beliefs about naloxone causing higher risk drug use are widespread, they are largely unfounded; research indicates that acquisition of naloxone by PWUIO does not increase high risk behaviors [ 80 ] and may actually decrease high risk drug use behaviors [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study

et al. 2022

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Background Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention. Methods Eligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey (N = 260), conducted February-July 2020. Results Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone. Conclusions Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

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“…Expected the person at the counter to treat you with respect f 55 (81) Were worried what the pharmacy staff would think of you when asking for naloxone f 27 (40) Were worried about confidentiality f 30 (44) Got all the information needed during the purchase to confidently respond to an overdose f 30 (44) Would go to a pharmacy for naloxone again f 54 (79) was echoed in the qualitative interviews, in which most participants reported getting free naloxone from support groups. Interview participants also spoke of a lack of knowledge surrounding the NSO, which served as a barrier to utilizing pharmacies for naloxone purchase.…”

Section: Table 1 (Continued)mentioning

confidence: 99%

“…In addition, although existing US research has explored perspectives on naloxone from pharmacists and pharmacy staff [21,[28][29][30][31][32][33][34][35][36], other healthcare providers [37][38][39][40][41], law enforcement [42][43][44][45][46][47][48], and the general public [49][50][51], there remains a gap in knowledge regarding the perspectives of family members and friends of people who use illicit opioids (particularly those who do not currently use illicit opioids themselves), despite US Surgeon General guidelines [8], and the high likelihood that they will be called upon to respond to an overdose [52]. One study reported that as many as 35% of parents of children who use illicit opioids (PWUIO) have been witness to an opioid overdose [53].…”

Section: Introductionmentioning

confidence: 99%

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

Slocum

Ozga

Walley

et al. 2021

Preprint

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Background: Expanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.Methods: Eligible bystanders were Massachusetts residents >18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N=22) were conducted to inform the development of a subsequent quantitative survey (N=260). Results: Most survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone.Conclusions: Despite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

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Improved Emergency Medicine Physician Attitudes Towards Individuals with Opioid Use Disorder Following Naloxone Kit Training

Cited by 10 publications

References 26 publications

Promoting Opioid Awareness Through a Union-Based Peer Training Model

Promoting Opioid Awareness Through a Union-Based Peer Training Model

If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study

If We Build It, Will They Come? Perspectives on Pharmacy-Based Naloxone Among Family and Friends of People who use Opioids: A Mixed Methods Study

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