Results From the Naloxone Awareness and Perceptions in Opioid Populations (NAPOP) Study

Purpose: Naloxone is a potent opioid antagonist used to reverse an opioid overdose.(1) Although those with opioid use disorder (OUD) are at elevated risk for overdose, Centers for Disease Control and Prevention prescribing guidelines identify other overdose risk factors within the therapeutic sphere.(2) suggesting that naloxone may be beneficial to different opioid populations.(3) This study compared knowledge, awareness, and perceptions associated with opioid overdose risk and naloxone between 2 types of high-risk opioid-using populations.

Methods: An online questionnaire was distributed to 2 samples of opioid users for a 1-month period in June 2020. The OUD arm (n=152) consisted of individuals who previously sought treatment for OUD. The chronic prescription opioid use (CPOU) arm (n=190) comprised individuals diagnosed with chronic pain (>3 months) currently treated with an opioid prescription (>3 months and either >50 daily morphine milligram equivalent or co-use of a benzodiazepine), and restricted by several confounders.

Results: Although the majority (73.2%) of CPOU patients were high-dosage users, only 5.8% perceived their prescription as high dose. Moreover, 52.6% used benzodiazepines, but only 47% of those knew of the increased overdose risk associated with concomitant benzodiazepine use. Risk perception varied between the 2 study arms, with 60.0% and 28.9% of CPOU and OUD patients, respectively, reporting that they were “not at all concerned about overdosing,” and 62.1% of CPOU patients vs 19.1% of OUD patients believing that they had “no risk” of opioid overdose.

Naloxone awareness also differed between the 2 groups. In the CPOU and OUD arms, 75.3% vs 98.0% of patients, respectively, were aware of naloxone. Only 13.5% of CPOU patients considered themselves knowledgeable about naloxone, and only 47.1% indicated that they could recognize any symptoms of opioid overdose (vs 84.1% of OUD patients). Perceived need for naloxone was lower among CPOU vs OUD patients; 71.8% and 48.3%, respectively, believed they did not need to regularly keep naloxone, and 22.6% and 35.0% indicated any likelihood of obtaining naloxone in the future.

Finally, perceptions of healthcare professionals differed between the 2 groups, with 65.0% of CPOU patients and 22.0% of OUD patients considering pharmacists/healthcare providers to be “extremely knowledgeable” about naloxone. CPOU patients were more likely to access naloxone from healthcare providers (34.7%) or emergency services/first responders (26.7%), whereas OUD patients were more likely to access naloxone through mental health/addiction resources (32.9%) or a community/social program (17.1%). Finally, OUD patients were more likely than CPOU patients to have experienced opioid-related stigma from healthcare professionals (72.5% vs 33.7%, respectively).

Conclusions: These data suggest that high-risk opioid user groups significantly differ in perceptions of opioid overdose risk and naloxone. CPOU patients had low perceived risk of or concern about opioid overdose despite having multiple risk factors, whereas patients with OUD had low recognized need for naloxone despite being aware of their overdose risk. Both groups reported low likelihoods of obtaining naloxone. Changes in access or distribution of naloxone should be data driven, and interventions surrounding naloxone education and access may need to stem from different sources depending on the opioid population.

References: References
1. Ryan SA and Dunne RB. Pain Manag. 2018;8(3):231-245.
2. Dowell D, et al. JAMA. 2016;315(15):1624-1645.
3. Rose C, et al. Psychiatr Serv. 2019;70(2):90-96.

Learning Objective: To identify differences in perceptions and knowledge of naloxone between two types of opioid using populations