Current practices in naloxone prescribing upon hospital discharge
DOI:
https://doi.org/10.5055/jom.2019.0524Keywords:
naloxone, opioid use disorder, opioid overdoseAbstract
Objective: To evaluate current practices in naloxone prescribing upon hospital discharge.
Design: Electronic cross-sectional survey.
Setting: Academic medical center.
Participants: Inpatient physicians and advanced practice providers.
Main outcome measures: Respondents completed survey items including current naloxone prescribing practices, barriers to naloxone prescribing, and methods to improve naloxone prescribing.
Results: The survey response rate was 51.6 percent. Greater than 90 percent of respondents agreed that naloxone should be prescribed for patients with an active opioid use disorder, history of overdose, and use of greater than 50 morphine milligram equivalents per day. Lack of patient education on proper use of naloxone was the most identified barrier to prescribing.
Conclusions: Providers agree with the Centers for Disease Control and Prevention recommendations to prescribe naloxone to high-risk patients. Certain barriers affect the rate of naloxone prescribing at discharge, including lack of time, patient education, provider training, and concern for increasing riskier behaviors.
References
Scholl L, Seth P, Kariisa M, et al.: Drug and opioid-involved overdose deaths—United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019; 67 (5152): 1419-1427.
Chen Q, Larochelle MR, Weaver DT, et al.: Prevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open. 2019; 2 (2): e187621. doi:10.1001/jamanetworkopen.2018.7621.
Jalal H, Buchanich JM, Roberts MS, et al.: Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science. 2018; 361 (6408): eaau1184.
Sun EC, Dixit A, Humphreys K, et al.: Association between concurrent use of prescription opioids and benzodiazepines and overdose: Retrospective analysis. BMJ. 2017; 356: j760.
Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315 (15): 1624-1645.
Guy GP Jr, Zhang K, Bohm MK, et al.: Vital signs: Changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017; 66 (26): 697-704.
Luu H, Slavova S, Freeman PR, et al.: Trends and patterns of opioid analgesic prescribing: Regional and rural-urban variations in Kentucky from 2012 to 2015. J Rural Health. 2019; 35 (1): 97-107.
Herzig SJ, Rothberg MB, Cheung M, et al.: Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals. J Hosp Med. 2014; 9 (2): 73-81.
Calcaterra SL, Yamashita TE, Min SJ, et al.: Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016; 31 (5): 478-485.
Oyler DR, Deep KS, Chang PK: Opioid use in the acute setting: A survey of providers at an academic medical center. J Opioid Manag. 2018; 14 (3): 203-210.
Mudumbai SC, Lewis ET, Oliva EM, et al.: Overdose risk associated with opioid use upon hospital discharge in veterans health administration surgical patients. Pain Med. 2019; 20 (5): 1020-1031. doi:10.1093/pm/pny150.
Ladha KS, Gagne JJ, Patorno E, et al.: Opioid overdose after surgical discharge. JAMA. 2018; 320 (5): 502-504.
McDonald R, Strang J: Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016; 111 (7): 1177-1187.
Substance Abuse and Mental Health Services Administration: Medications for opioid use disorder for healthcare and addiction professionals, policymakers, patients, and families. Treatment Improvement Protocol (TIP) 63. Available at https://store.samhsa.gov/system/files/sma18-5063fulldoc.pdf. Accessed January 24, 2019.
US Department of Health & Human Services: Naloxone: The opioid reversal drug that saves lives. Available at https://www.hhs.gov/opioids/sites/default/files/2018-12/naloxone-coprescribing-guidance.pdf. Accessed January 24, 2019.
Freeman PR, Hankosky ER, Lofwall MR, et al.: The changing landscape of naloxone availability in the United States, 2011–2017. Drug Alcohol Depend. 2018; 191: 361-364.
Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42 (2): 377-381.
Doleac JL, Mukherjee A: The moral hazard of lifesaving innovations: Naloxone access, opioid abuse, and crime. SSRN. Available at https://ssrn.com/abstract=3170278. Accessed January 24, 2019.
Greene J: Naloxone “moral hazard” debate pits economists against physicians. Ann Emerg Med. 2018; 72 (2): A13-A16.
Huhn AS, Dunn KE: Why aren’t physicians prescribing more buprenorphine? J Subst Abuse Treat. 2017; 78: 1-7.
Hutchinson E, Catlin M, Andrilla CH, et al.: Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014; 12 (2): 128-133.
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved
