• Ingrid A Binswanger, Stephen Koester, Shane R Mueller, Edward M Gardner, Kristin Goddard, and Jason M Glanz.
• Institute for Health Research, Kaiser Permanente Colorado, P.O Box 378066, Denver, CO, 80237-8066, USA. Ingrid.A.B.inswanger@kp.org.
• J Gen Intern Med. 2015 Dec 1; 30 (12): 1837-44.

BackgroundThe rate of fatal unintentional pharmaceutical opioid poisonings has increased substantially since the late 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in the event of an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription.ObjectiveOur aim was to investigate the knowledge, attitudes and beliefs about overdose education and naloxone prescription among clinical staff in primary care.DesignThis was a qualitative study using focus groups to elucidate both clinic-level and provider-level barriers and facilitators.SettingTen primary care internal medicine, family medicine and infectious disease/HIV practices in three large Colorado health systems.MethodsA focus group guide was developed based on behavioral theory. Focus group transcripts were coded for manifest and latent meaning, and analyzed for themes using a recursive approach that included inductive and deductive analysis.ResultsThemes emerged in four content areas related to overdose education and naloxone prescription: knowledge, barriers, benefits and facilitators. Clinical staff (N = 56) demonstrated substantial knowledge gaps about naloxone and its use in outpatient settings. They expressed uncertainty about who to prescribe naloxone to, and identified a range of logistical barriers to its use in practice. Staff also described fears about offending patients and concerns about increased risk behaviors in patients prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors.LimitationsFindings from these qualitative focus groups may not be generalizable to other settings.ConclusionIn addition to evidence gaps, logistical and attitudinal barriers will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain.

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