Why is naloxone prescription not more common in emergency departments? A survey of physician practices and attitudes

Abstract

Objective: Emergency physicians (EPs) have a singular opportunity to prescribe naloxone and decrease fatal overdoses in opioid users. We surveyed EPs patterns of naloxone prescription and identified barriers to prescribing naloxone. Design: Surveys were conducted at an emergency medicine conference from 2018 to 2019. We used a Likert scale for all questions and a chi-square or chi-square for trend tests to determine statistical significance. Setting: Emergency medicine conferences and emergency departments. Participants: Forty-one EPs were surveyed. Intervention: Oral survey. Main outcome measures: Prevalence of naloxone prescription and EP attitude toward naloxone. Results: 65.0 percent of residents and 33.3 percent of attending physicians had never prescribed naloxone to patients. 90.2 percent believed ED naloxone prescription is safe, 82.9 percent did not refrain from prescribing due to ethical concerns, and 73.2 percent believed it is not a waste of resources. Conclusions: Many resident physicians had never prescribed naloxone despite agreeing it was safe, ethical, and a productive use of resources. The time needed to counsel patients on naloxone use was a barrier to prescription, and various interventions are needed to make this practice more common.