Awareness of state legislation on naloxone accessibility associated with willingness to prescribe naloxone

ABSTRACT

Background: Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution. Methods: Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems' institutional review boards. Results: Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n = 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5–22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3–15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation (r = 0.43, P < .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone (r = 0.37, P < .0001), general knowledge (r = 0.24, P = .0032), and perception of professional responsibility (r = 0.19, P = .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws (P = .0016) and self-confidence about dosing, prescribing, and writing protocols (P = .0011). Conclusions: Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.

KEYWORDS:

• Awareness
• legislation
• naloxone
• opioid
• overdose
• prescriber
• prevention
• survey
• willingness

Acknowledgments

We thank Marilyn Odean, MS, Whiteside Institute for Clinical Research, Duluth, MN, and Gina Lemke, PharmD, Director of Pharmacy, St. Luke's Hospital and Clinics for their assistance with the survey implementation procedures and communications to prescribers.

The authors declare that they have no conflicts of interest.

Author contributions

Dr. Schneiderhan is the principal investigator, corresponding/co-first author, and key contributor in research conception, analyses, and interpretation of results, and major contributor to manuscript write-up. Dr. Okoro is the co-principal investigator and co-first author providing major contributions to survey development, methodology, analyses, interpretation of results, and manuscript write-up. Dr. Bastianelli is a co-investigator and contributed to survey development, methodology, and interpretation of results. Dr. Ya-Feng Wen contributed to data management, analyses, and interpretation of results. Dr. Bilden is a co-investigator and was a key contributor in survey design, methodology, and interpretation of results. Dr. Konowalchuk is a co-investigator and was a key contributor in the survey design, administration of the survey and methodology, and interpretation and dissemination of the results within his institution.