Public Access to Naloxone: Exploring Intention to Prescribe Among Tennessee Nurse Practitioners

Background Drug overdose deaths have become an escalating epidemic in the U.S. and surpassed motor vehicle collisions as the leading cause of accidental death. To combat opioid overdose, naloxone distribution to the public has been initiated in some states as a harm reduction strategy. Naloxone has been used for many years among hospital professionals as a life-saving antidote to reverse the respiratory depression effects of opioids, and the FDA has approved take-home naloxone devices for layperson use. Though legislation has been introduced in many states, such as Tennessee, to allow provider prescription of naloxone to laypersons, minimal data have been recorded to determine if NPs are willing to prescribe naloxone to patients. Purpose The purpose of this project was to explore how knowledge, attitudes, and subjective norms influence intentions to prescribe naloxone to laypersons among Tennessee nurse practitioners (NPs) following implementation of state naloxone distribution laws. Methods Using the Theory of Reasoned Action as the theoretical framework, NPs’ knowledge, attitudes, subjective norms, and intentions to prescribe naloxone were assessed using web-based surveys. While 6,196 Tennessee NPs were emailed the survey, purposive sampling included only NPs practicing in adult primary care clinics, family practice clinics, pain management clinics, and emergency departments in the final sample. Descriptive and Pearson’s Chi-Square statistics were used to analyze survey responses and correlations were established using SPSS software. Results Of 343 NPs included in the final sample, only 16.6% intended to prescribe naloxone to laypersons, which significantly correlated with NPs’ knowledge, attitudes, and subjective norms. No significant correlation was found between geographical location and intention to prescribe. Intention to prescribe percentages increased dramatically from 16.6% to 58% when NPs were asked if they would prescribe naloxone to laypersons with prescribing protocols in place. Discussion This study’s results confirmed the literature’s suggestion that healthcare providers are relatively unaware of the evidence surrounding naloxone distribution safety and efficacy. Negative attitudes toward naloxone distribution and uncertainty over legal protection contributed to unwillingness to prescribe. Better education, training, legal clarification, and prescribing protocols should be given to NPs and other healthcare providers to increase involvement with naloxone prescription for laypersons Across the globe, drug overdose has become a devastating epidemic and surpassed motor vehicle collisions as the leading cause of adult accidental death in the United States (U.S.) (Centers for Disease Control and Prevention [CDC], 2015a). Of the annual U.S. death toll, pharmaceuticals contributed to approximately 22,767 overdose deaths with 71.3% related to opioid pain medications (CDC, 2015a). For many years, the life-saving opioid antidote, known as naloxone, has been used among healthcare professionals in hospitals to quickly and effectively reverse the respiratory depressive effects of opioids (Wermeling, 2015). Public health efforts and current legislation have focused on distributing naloxone to non-medically trained laypersons and training these laypersons to administer naloxone to victims in opioid overdose events. This Doctor of Nursing Practice (DNP) project explored the psychosocial factors influencing nurse practitioners’ (NPs’) intentions to prescribe naloxone to laypersons as an opioid overdose prevention strategy