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Prescribing Naloxone for Opiate Overdose: Doctors’ Concern

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Physicians Express Concern About Prescribing Naloxone for Opiate Overdose

In the face of a fourfold increase in fatalities from drug overdose in the United States since 1999, policymakers are scrambling to implement new strategies to combat the nation’s drug problem. Prescription drugs, particularly opioid painkillers, are the largest contributors to drug-related fatalities. As a result, many states have amended their laws to expand access to naloxone, a drug that can reverse the effects of opiates and prevent overdose. However, a recent study found that physicians have some concerns about prescription of naloxone that have yet to be resolved.

What Is Naloxone?

Naloxone also goes by its trade name, Narcan. When prescription opiates enter the bloodstream, they bind to opioid receptors on brain cells, triggering effects that depress the central nervous system. Naloxone is an opioid antagonist, meaning that it binds to the opioid receptors very strongly and blocks the effects of opiates. When administered to a person experiencing a potentially fatal overdose, naloxone can increase heart rate and breathing, saving the person’s life.

Physician Concerns about Prescribing Naloxone for Overdose Prevention

In light of growing concern about the nation’s prescription drug abuse epidemic, 34 states have expanded laws to make it easier for doctors to prescribe naloxone or to limit the legal repercussions for bystanders or family members to administer the drug to a person who has overdosed. However, a recent study by scientists at Kaiser Permanente, the University of Colorado School of Medicine, and the Denver Health Medical Center found that many physicians have remaining concerns about prescribing naloxone.
Although the majority of physicians believed that prescribing naloxone could prevent overdose and improve patient understanding of the risks of opiate use, few of them had actually prescribed naloxone to a patient. Many clinicians said that they did not want to offend patients by talking about their opioid overdose risk. Additionally, some doctors were worried about the potential for bystanders to administer naloxone improperly. They believed that safe, confidential training was needed before bystanders could be qualified to provide naloxone to a person experiencing an overdose.
Finally, a number of the doctors studied were worried that widespread prescription of naloxone may cause people dealing with opiate dependence to take the risks of opioid overdose less seriously. These doctors believed that a naloxone prescription might act as a sort of “safety net” that would cause patients to underestimate the dangerous risks of opiate use.

Toward a Comprehensive Policy: Preventing Overdoses Before They Occur

Naloxone can certainly be an effective tool in treating overdoses as they occur, but many addiction experts believe that there needs to be increased emphasis on preventing those overdoses from occurring at all. First, physicians should be trained to screen patients for opiate addiction and to discuss their opiate use in a safe, non-threatening, and confidential manner. Primary care doctors are in a great position to identify problematic opiate use and refer patients for treatment, but they must be comfortable addressing these issues with patients.
Additionally, a comprehensive policy for prevention of opiate dependence must focus on improving access to effective treatments. Effective drug policy should focus on motivating people to seek treatment before they risk a fatal opioid overdose and require the use of naloxone.

Source

Legal Interventions To Reduce Overdose Mortality: Naloxone Access And Overdose Good Samaritan Laws. The Network for Public Health Law. Retrieved June 22, 2015.

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