Medical providers' knowledge and concerns about opioid overdose education and take-home naloxone rescue kits within Veterans Affairs health care medical treatment settings

ABSTRACT

Background: Overdose from opioids is a serious public health and clinical concern. Veterans are at increased risk for opioid overdose compared with the civilian population, suggesting the need for enhanced efforts to address overdose prevention in Department of Veterans Affairs (VA) health care settings, such as primary care clinics. Methods: Prescribing providers (N = 45) completed surveys on baseline knowledge and concerns about the VA Overdose Education and Naloxone Distribution (OEND) initiative prior to attending an OEND educational training. Results: Survey items were grouped into 4 OEND-related categories, reflecting (1) lack of knowledge/familiarity/comfort; (2) concerns about iatrogenic effects; (3) concerns about impressions of unsafe opioid prescribing; and (4) concerns about risks of naloxone prescribing. Although certain OEND-related categories were associated with each other, concerns related to iatrogenic effects of OEND (e.g., patients will use more opioids and/or be less likely to see treatment) and lack of knowledge/familiarity/comfort with OEND were endorsed more than concerns related to giving impressions of unsafe opioid prescribing. The majority of providers endorsed the belief that those prescribing opioids to patients should be responsible for providing overdose education to those patients. System-wide naloxone prescription rates and sources increased over 320% following initiation of OEND expansion efforts, although these increases cannot be viewed as a direct result of the in-service trainings. Conclusions: Findings demonstrate that some providers believe they lack knowledge of opioid overdose prevention techniques and hold concerns about OEND implementation. More training of medical providers outside substance use treatment settings is needed, with particular attention to concerns about harmful consequences resulting from the receipt of naloxone.

KEYWORDS:

• Naloxone
• overdose education
• opioid
• risk compensation
• primary care
• OEND

Funding

This material is the result of work supported with resources and the use of facilities at the VA St. Louis Health Care System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. The authors declare they have no conflicts of interest.

Author contributions

Rachel P. Winograd, PhD, led the research conceptualization, design, data collection, analysis, and manuscript preparation efforts for this project, with crucial input, guidance, and consistent participation from all 4 coauthors. Corey S. Davis, JD, MPH, contributed significantly to this project through consultation on survey design and content, feedback on the formulation of the analytic approach, and heavy manuscript preparation and revision, with particular focus on naloxone access and policy. Elizabeth Oliva, PhD, added to this project by creating many of the foundational materials necessary for study implementation, serving as a primary program consultant throughout the project, and providing crucial manuscript revisions for publication. Maria E Niculete, PhD, contributed significantly to the research conception and survey design, the data analytic strategy, interpretation of the results, and crafting and editing the final manuscript. Last, Richard P. Martielli, PhD, contributed to this project by providing insight into the study conceptualization, serving as principal investigator for the IRB approval process, and readying the manuscript for submission to publication by making significant format and content changes.