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A Survey of Prescribers' Attitudes, Knowledge, Comfort, and Fear of Consequences Related to an Opioid Overdose Education and Naloxone Distribution Program

Peckham, Alyssa, M., PharmD, BCPP; Niculete, Maria, E., PhD; Steinberg, Howard, PhD; Boggs, Douglas, L., PharmD, MS, BCPP

Journal of Public Health Management and Practice: July/August 2018 - Volume 24 - Issue 4 - p 310–317
doi: 10.1097/PHH.0000000000000668
Research Reports: Research Full Report

Context: The alarming increase in opioid-related fatalities has placed the United States in the midst of an opioid epidemic. In an effort to reduce opioid-related fatalities, each Veterans Affairs (VA) hospital is responsible for development of an OEND (Overdose Education and Naloxone Distribution) program to enhance naloxone distribution.

Objective: To assess attitudes, knowledge, comfort level, and fear of consequences at the prescriber level related to the OEND program at VA Connecticut Healthcare System (VACHS).

Design: Anonymous surveys were administered to VACHS prescribers to assess attitude, knowledge, comfort level, and fear of consequences using a 5-point Likert scale.

Setting: VACHS.

Participants: VACHS prescribers (primary care physicians/internists, psychiatrists, physician assistants/advanced practice registered nurses, pharmacists) in primary care/medicine, mental health, and substance use disorder (SUD).

Methods: Differences across 4 domains were analyzed using analysis of variance testing, and pairwise post hoc analysis was conducted using Tukey's HSD for all significant findings. Regression modeling was conducted to evaluate correlations between each group and survey responses.

Main Outcome: Identify differences and potential barriers to program implementation across professions and practice specialty.

Results: While primary care/medicine, mental health, and SUD prescribers had positive attitudes toward dispensing naloxone, SUD clinicians reported being more comfortable, more knowledgeable, and less fearful of consequences. In general, psychiatrists reported to be more knowledgeable and comfortable prescribing naloxone. In addition, prescribers who received naloxone training reported themselves to be more comfortable, more knowledgeable, and less fearful of the consequences of dispensing naloxone.

Conclusions: Results indicate that barriers to OEND implementation continue to exist, and not all clinicians or practice specialties at VACHS are comfortable with dispensing naloxone. A targeted approach to training health care clinicians may lead to increased acceptance of naloxone dispensing. Additional research is needed to elicit the best method of improved acceptance of naloxone to expand naloxone access.

Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, Glendale, Arizona (Dr Peckham); VA Connecticut Healthcare System, West Haven, Connecticut (Drs Niculete, Steinberg, and Boggs); and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Drs Niculete, Steinberg, and Boggs).

Correspondence: Douglas L. Boggs, PharmD, MS, BCPP, VISN 1 Academic Detailer, 950 Campbell Ave, West Haven, CT 06516 (

This material is the result of work supported with resources and the use of facilities at the VA Connecticut Healthcare System, West Haven, CT. The views expressed are those of the authors and do not reflect the position of the Department of Veterans Affairs or the United States Government.

Conflicts of interest and source of funding: None declared.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.