Utah's Opioid Overdose Epidemic: Co-prescribing Naloxone for Long-term Opioid Users

Background: Accidental opioid overdose is the leading cause of injury deaths in the state of Utah, even surpassing motor vehicle accidents. On average, 52 Utah adults die every month from drug poisoning. Currently, Utah is ranked 7th highest in the nation for opioid related overdoses. Co-prescribing naloxone has been proven to decrease risky opioid use and subsequent overdose. The state of Utah has passed bills to allow for co-prescribing naloxone and layperson use of naloxone without medical supervision, yet it remains to be the standard of care. Specific aims/objectives: The primary purpose of this project is to encourage physicians to recommend and co-prescribe naloxone when it is appropriate and evaluate their willingness to do so. The secondary purpose is to assess providers working with chronic pain patients on their perceived barriers and benefits to co-prescribing naloxone. Methods: Extensive research and delivery of evidence-based information including statistical data on Utah's current opioid overdose problem and laws surrounding naloxone provision; introduction of evidence-based guidelines on naloxone provision; pre-emptive refutation of arguments against naloxone distribution; and sympathetic narrative of the lives taken by opioid overdose. Intervention: Presentation given to a group of 12 providers in a rural hospital in the state of Utah. An 8-question pre- and post-survey was created to evaluate the providers' current beliefs on the opioid problem in the state of Utah, including their perceptions of impact the state has had on the problem, the relevancy of the problem to their practice, whether they have instituted prior safeguards in their own practice, how frequently they have previously prescribed naloxone, and what benefits or barriers they perceive to co-prescribing naloxone. The pre- and post-survey was created using four survey types, including Likert-type scales, dichotomous, demographic and open-ended questions. Results: All of the providers surveyed agreed that the opioid epidemic is a problem in the state of Utah; 19% (0.22 pre-survey, 0.16 post-survey) of providers agree that Utah has made any significant impact on the crisis (p=0.849 by fisher's exact test); 81% (0.77 pre-survey, 0.83 post-survey; p = 1 by fisher's exact test) of respondents stated they have made prescribing practice changes as a result of the opioid epidemic; 22% (N=9 completed surveys) had previously recommended or prescribed naloxone between 1-5 times within the last 60 days; 66% (N=6 completed surveys) of the providers either recommended or prescribed naloxone 1-5 times 60 days following the intervention; p = 0.136 by fishers exact test. The most common perceived barrier is making naloxone provision a routine practice, either by remembering to do it, or having systems in place to make it automatic. The most common perceived benefit to naloxone provision is decreased mortality by either preventing or reversing opioid drug overdose. Conclusions: Providers play a crucial role in discussing the inherent risks of opioid drugs and subsequent risks of overdose. Naloxone provision may initiate this discussion, decreasing risky opioid use altogether and reducing the occurrence of overdose.