Academic physicians' and medical students' perceived barriers toward bystander administered naloxone as an overdose prevention strategy

Aims: To identify perceived barriers to the prescription of naloxone to third-party contacts of opiate users. Design: Qualitative descriptive study. Setting: Two academic hospitals in Baltimore, MD, USA. Participants: Thirty medical providers, including both physicians and medical students. Measurements: Qualitative; in-depth interviews and focus groups analyzed using line-by-line, focused, and axial coding based on methods adapted from grounded theory. Findings: Academic physicians and medical students cited three categories of barriers to naloxone prescription related to drug, provider, and patient characteristics. Concerns about naloxone itself included inability to prevent addictive behaviors, duration of action, medical risks, expiration date, and route of administration. Concerns about medical providers included lack of knowledge or experience, medical community common practices and norms, insufficient provision of third-party education, physician and clinic scheduling practices, worry about insulting patients, and fear of being viewed as enabling drug abuse. Concerns about patients included increased risk-taking behaviors, opiate withdrawal symptoms, potential repeat overdose related to withdrawal-discomfort, decreased contact with medical providers, and stigma. Conclusions: Minimizing barriers to naloxone provision may increase acceptability and prescription practice in the medical community. Addressing these barriers from multiple provider perspectives is critical to advance naloxone prescription as a harm reduction strategy, which has the potential to prevent opiate overdoses.