Patient perspectives of barriers to naloxone obtainment and use in a primary care, underserved setting: A qualitative study

Abstract

Background: Gaps in naloxone obtainment and use are not well studied, particularly among minoritized groups. Objective: To describe patient perspectives that serve as barriers to naloxone obtainment and the number of patients who obtained naloxone in a primarily African American population in a primary care, underserved setting. Methods: This qualitative study conducted semi-structured interviews and included 36 adults who were prescribed naloxone at a federally qualified health center using convenience sampling. Participants answered survey questions describing naloxone acceptability, perceived risk for overdose, and barriers to naloxone use. Results: Sixty-nine percent of the patients were Black or African American. The majority of patients attempted to fill their naloxone at a local pharmacy (69%) and reported no difficulties (88%). Five major themes revealed: overall positive views of naloxone because it saves lives; existing knowledge gaps related to indications for naloxone prescription; stigma surrounding receiving a naloxone prescription; inadequacies of the patient education provided; and the role providers play in naloxone receptivity Conclusions: Among a majority African American population, many perceived naloxone to be lifesaving. However, stigmatizing perceptions and inability to recall patient education contribute to a perception of low overdose risk. Further research describing the impact of the opioid epidemic on underrepresented groups is necessary.

Keywords:

• Naloxone
• opioid-related disorders
• primary health care
• vulnerable populations

Acknowledgments

The authors would like to acknowledge Coffin and colleagues for approving our adaptation of their survey utilized to assess patient experience with naloxone prescription. Additionally, the authors would like to thank Drs. Michelle Healy and Jean Marsters for creating the materials and delivering the naloxone training at the clinic. The authors would also like to thank the study participants as well as the clinic staff for their support.

Author contributions

J.K. was principal investigator on this study, helped develop the study protocol, enrolled subjects, conducted interviews, coded transcripts, reconciled coded transcripts, conducted theme extraction and analysis, and contributed to and revised the final manuscript. E.C. helped develop the study protocol, coded transcripts, reconciled coded transcripts, conducted theme reconciliation, and contributed to and revised the final manuscript. S.D. helped develop the study protocol and contributed to and revised the final manuscript.