Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep-Oct;17(5):598-603.
doi: 10.1097/ADM.0000000000001190. Epub 2023 Jun 6.

Prescribe to Save Lives: An Intervention to Increase Naloxone Prescribing Among HIV Clinicians

Peter D Friedmann  1 , Raagini Jawa, Donna Wilson, Susan E Ramsey, Randall Hoskinson Jr, Michelle McKenzie, Alexander Y Walley, Traci C Green, Jeffrey Bratberg, Josiah D Rich
Affiliations

Prescribe to Save Lives: An Intervention to Increase Naloxone Prescribing Among HIV Clinicians

Peter D Friedmann et al. J Addict Med. 2023 Sep-Oct.

Abstract

Objectives: Overdose is a major cause of preventable death among persons living with HIV. This study aimed to increase HIV clinicians' naloxone prescribing, which can reduce overdose mortality.

Methods: We enrolled 22 Ryan White-funded HIV practices and implemented onsite, peer-to-peer training, posttraining academic detailing, and pharmacy peer-to-peer contact around naloxone prescribing in a nonrandomized stepped wedge design. Human immunodeficiency virus clinicians completed surveys to assess attitudes toward prescribing naloxone at preintervention and 6 and 12 months postintervention. Aggregated electronic health record data measured the number of patients with HIV prescribed and the number of HIV clinicians prescribing naloxone by site over the study period. Models controlled for calendar time and clustering of repeated measures among individuals and sites.

Results: Of 122 clinicians, 119 (98%) completed a baseline survey, 111 (91%) a 6-month survey, and 93 (76%) a 12-month survey. The intervention was associated with increases in self-reported "high likelihood" to prescribe naloxone (odds ratio [OR], 4.1 [1.7-9.4]; P = 0.001). Of 22 sites, 18 (82%) provided usable electronic health record data that demonstrated a postintervention increase in the total number of clinicians who prescribed naloxone (incidence rate ratio, 2.9 [1.1-7.6]; P = 0.03) and no significant effects on sites having at least one clinician who prescribed naloxone (OR, 4.1 [0.7-23.8]; P = 0.11). The overall proportion of all HIV patients prescribed naloxone modestly increased from 0.97% to 1.6% (OR, 2.2 [0.7-6.8]; P = 0.16).

Conclusion: On-site, practice-based, peer-to-peer training with posttraining academic detailing was a modestly effective strategy to increase HIV clinicians' prescribing of naloxone.

PubMed Disclaimer

Conflict of interest statement

Dr. Ramsey declared an Investigator Sponsored Research Agreement with Gilead Science, Inc. for the provision of medication for another trial. For the remaining authors, no conflicts of interest were declared.

Figures

Figure 1.
Figure 1.
Schematic of the Prescribe to Save Lives Intervention and Outcomes.
Figure 2.
Figure 2.. Pre- vs post-intervention mean change in score of clinician attitudes towards prescribing naloxone.
Derived from continuous 0-100 scales on clinician prescriber surveys. The total N for any survey participation is 122, with 119 clinician prescribers (98%) completing the baseline survey, 111 (91%) the 6-month survey, 93 (76%) the 12-month survey, and 89 (73%) all 3 surveys. Abbreviations: Confidence Interval- CI
See this image and copyright information in PMC

References

    1. Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. NCHS Data Brief. Sep 2009(22):1–8. - PubMed
    1. Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2022. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm accessed 12/4/2022.
    1. Sun J, Mehta SH, Astemborski J, et al. Mortality among people who inject drugs: a prospective cohort followed over three decades in Baltimore, MD, USA. Addiction. Aug 2 2021. - PMC - PubMed
    1. Canan CE, Chander G, Monroe AK, et al. High-Risk Prescription Opioid Use Among People Living With HIV. J Acquir Immune Defic Syndr. Jul 1 2018;78(3):283–290. - PMC - PubMed
    1. Green TC, McGowan SK, Yokell MA, Pouget ER, Rich JD. HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS. Feb 20 2012;26(4):403–417. - PMC - PubMed

Publication types

MeSH terms