Internal Medicine Residents’ Feelings of Responsibility, Confidence, and Clinical Practice in Opioid Overdose Prevention and Naloxone Prescribing

Abstract

Objectives: 

We assessed internal medicine residents’ attitudes and clinical practices regarding opioid overdose prevention education and naloxone prescribing as a first step in developing curriculum to train residents on these topics.

Methods: 

We adapted a previously validated questionnaire to assess residents’ feelings of responsibility, confidence and clinical practice in opioid overdose prevention and naloxone prescribing.

Results: 

Nearly all 90 residents (62% response rate) felt responsible and most felt confident in: assessing patients for risk of opioid overdose (95% and 57%, respectively), assessing patients’ readiness to reduce risk of opioid overdose (95% and 73%, respectively), and advising behavior change to minimize opioid overdose risk (98% and 71%, respectively). Most felt responsible to refer patients for opioid use disorder (OUD) treatment (98%), and provide overdose prevention education and prescribe naloxone (87%). Most felt confident referring patients for OUD treatment (60%), and nearly half felt confident in providing overdose prevention education and prescribing naloxone (45%). In clinical practice, over a third reported assessing patients’ risk of overdose (35%), assessing patients’ readiness to reduce risk of overdose (57%), and advising behavior change to minimize overdose risk (57%). Only 17% reported providing overdose prevention education and prescribing naloxone.

Conclusions: 

Despite feeling responsible and confident in addressing opioid overdose prevention strategies, few residents report implementing these strategies in clinical care. Residency programs must not only include curricula addressing overdose risk assessment and counseling, referral to or provision of OUD treatment, but also include curricula that impact implementation of opioid overdose prevention strategies.