TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Attitude of Health Personnel
KW - Chronic Pain/drug therapy
KW - Drug Overdose/therapy
KW - Humans
KW - Naloxone/therapeutic use
KW - Narcotic Antagonists/therapeutic use
KW - Physicians, Primary Care/statistics & numerical data
KW - Practice Patterns, Physicians'/statistics & numerical data
KW - Surveys and Questionnaires
KW - naloxone co-prescription
KW - Opioid analgesics
KW - opioid overdose
KW - primary care
AU - Emily Behar
AU - Christopher Rowe
AU - Glenn-Milo Santos
AU - Diana Coffa
AU - Caitlin Turner
AU - Nina C. Santos
AU - Phillip O. Coffin
A1 - 
AB - BACKGROUND: Naloxone co-prescription is recommended for patients on long-term opioids for pain, yet there are few data on the practice. OBJECTIVE: To explore naloxone co-prescribing acceptability among primary care providers for patients on long-term opioids. DESIGN: We surveyed providers at six safety-net primary care clinics in San Francisco that had initiated naloxone co-prescribing. Providers were encouraged to offer naloxone to patients on long-term opioids or otherwise at risk of witnessing or experiencing an overdose. Surveys were administered electronically 4 to 11 months after co-prescribing began. KEY RESULTS: One hundred eleven providers (69 %) responded to the survey, among whom 41.4 % were residents; 40.5 % practiced internal medicine and 55.0 % practiced family medicine. Most (79.3 %) prescribed naloxone, to a mean of 7.7 patients; 99.1 % were likely to prescribe naloxone in the future. Providers reported they were likely to prescribe naloxone to most patients, including those on low doses, defined as /=65 years old (83.9 %), with no overdose history (80.7 %), and with no substance use disorder (73.6 %). Most providers felt that prescribing naloxone did not affect their opioid prescribing, 22.5 % felt that they might prescribe fewer opioids, and 3.6 % felt that they might prescribe more. Concerns about providing naloxone were largely administrative, relating to time and pharmacy or payer logistics. Internists (incidence rate ratio [IRR] = 0.49, 95 % CI = 0.26-0.93, p = 0.029), those licensed for 5-20 years (IRR = 2.10, 95 % CI = 1.35-3.25, p = 0.001), and those with more patients prescribed long-term opioids (IRR = 1.10, 95 % CI = 1.05-1.14, p <0.001) were independently more likely to prescribe a greater number of naloxone compared to participants without these exposures. CONCLUSIONS: Naloxone co-prescription is considered acceptable among primary care providers. Barriers such as time and dispensing logistics may be alleviated by novel naloxone formulations intended for laypersons recently approved by the U.S. Food and Drug Administration.
AD - San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA. Emily.behar@ucsf.edu.; University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA, 94143, USA. Emily.behar@ucsf.edu.; San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.; San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.; University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA, 94143, USA.; University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA, 94143, USA.; San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.; San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.; San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.; University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA, 94143, USA.
BT - Journal of general internal medicine
C5 - Education & Workforce; Opioids & Substance Use
CP - 3
CY - United States
DO - 10.1007/s11606-016-3911-z
IS - 3
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Naloxone co-prescription is recommended for patients on long-term opioids for pain, yet there are few data on the practice. OBJECTIVE: To explore naloxone co-prescribing acceptability among primary care providers for patients on long-term opioids. DESIGN: We surveyed providers at six safety-net primary care clinics in San Francisco that had initiated naloxone co-prescribing. Providers were encouraged to offer naloxone to patients on long-term opioids or otherwise at risk of witnessing or experiencing an overdose. Surveys were administered electronically 4 to 11 months after co-prescribing began. KEY RESULTS: One hundred eleven providers (69 %) responded to the survey, among whom 41.4 % were residents; 40.5 % practiced internal medicine and 55.0 % practiced family medicine. Most (79.3 %) prescribed naloxone, to a mean of 7.7 patients; 99.1 % were likely to prescribe naloxone in the future. Providers reported they were likely to prescribe naloxone to most patients, including those on low doses, defined as /=65 years old (83.9 %), with no overdose history (80.7 %), and with no substance use disorder (73.6 %). Most providers felt that prescribing naloxone did not affect their opioid prescribing, 22.5 % felt that they might prescribe fewer opioids, and 3.6 % felt that they might prescribe more. Concerns about providing naloxone were largely administrative, relating to time and pharmacy or payer logistics. Internists (incidence rate ratio [IRR] = 0.49, 95 % CI = 0.26-0.93, p = 0.029), those licensed for 5-20 years (IRR = 2.10, 95 % CI = 1.35-3.25, p = 0.001), and those with more patients prescribed long-term opioids (IRR = 1.10, 95 % CI = 1.05-1.14, p <0.001) were independently more likely to prescribe a greater number of naloxone compared to participants without these exposures. CONCLUSIONS: Naloxone co-prescription is considered acceptable among primary care providers. Barriers such as time and dispensing logistics may be alleviated by novel naloxone formulations intended for laypersons recently approved by the U.S. Food and Drug Administration.
PP - United States
PY - 2017
SN - 1525-1497; 0884-8734
SP - 291
EP - 295
EP - 
T1 - Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain
T2 - Journal of general internal medicine
TI - Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain
U1 - Education & Workforce; Opioids & Substance Use
U2 - 27815762
U3 - 10.1007/s11606-016-3911-z
VL - 32
VO - 1525-1497; 0884-8734
Y1 - 2017
Y2 - Mar
ER -