Addressing the opioid crisis: An assessment of clinicians' training experience, practices, and attitudes within a large healthcare organization.

OBJECTIVE: To assess provider practices and attitudes toward addiction care and pain management within a large healthcare system, as well as to determine the impact of prior training and perceived effectiveness of organizational implementation strategies. DESIGN: A cross-sectional study. SETTING: Large healthcare organization comprising 21 hospitals. PARTICIPANTS: Three hundred and thirteen healthcare providers within a large healthcare organization. MAIN OUTCOME MEASURES: Training, practices, and attitudes toward opioid-related care. METHODS: One thousand providers including physicians (MD/DO) and physician extenders (NP/PA) were contacted via email request. The Mann-Whitney test or Fisher's exact test, as appropriate, was used for comparisons of continuous and categorical variables, respectively. RESULTS: Providers lacked prior pain management (36 percent), addiction (38 percent), or buprenorphine training (92 percent). Few providers were confident in treating opioid use disorders (OUD) (19 percent) and opioid tapering (24 percent) but interested in safe prescribing practices (81 percent). While most providers preferred to refer patients for OUD (89 percent), only a small portion felt appropriate services were readily available (22 percent). Trained providers appear significantly more engaged in checking Prescription Drug Monitoring Program database [median = 1 (Q1 = 1, Q3 = 2) vs 2(1, 3); p < 0.001], comfortable obtaining urine drug screens [2(2, 3) vs 3(2, 4); p < 0.002], and willing to treat OUD with additional support [3(2, 4) vs 4(3, 4); p < 0.022] compared to non-trained providers. Primary care providers were more likely to view OUDs in their scope of practice [4(2, 5) vs 4(3, 5); p < 0.016] and willing to treat OUD with additional support [3(2, 3) vs 3(2, 4); p < 0.0007] compared to specialists. Buprenorphine providers appear to have more confidence in skills for OUD [2(1, 3) vs 4(3, 4); p < 0.0001] and tapering [2(1, 2) vs 4(3, 5); p < 0.0001], and diminished preference to refer [2(1, 5) vs 1(1, 2); p < 0.0009] compared to non-buprenorphine providers. CONCLUSIONS: Providers within a large healthcare system lack training and confidence in management of opioid-related care. Buprenorphine training positively modified key attitudes toward addiction care, yet engagement in medication-assisted treatment remains limited. Providers are concerned about opioid risks, and view guideline implementation and direct input from addiction specialists as effective organizational strategies. Further research is needed to clarify the efficacy of such approaches.

Awareness and Attitudes Toward Intranasal Naloxone Rescue for Opioid Overdose Prevention.

Opioid overdose prevention is a pressing public health concern and intranasal naloxone rescue kits are a useful tool in preventing fatal overdose. We evaluated the attitudes, knowledge, and experiences of patients and providers related to overdose and naloxone rescue. Over a six month period, patients and providers within a large community hospital in Staten Island were recruited to complete tailored questionnaires for their respective groupings. 100 patients and 101 providers completed questionnaires between August, 2014 and January, 2015. Patient participants were primarily Caucasian males with a mean age of 37.7 years, of which 65% accurately identified naloxone for opioid overdose, but only 21% knew more specific clinical features. 68% of patients had previously witnessed a drug overdose. Notably, 58% of patients anticipated their behavior would change if provided access to an intranasal naloxone rescue kit, of which 83% predicted an increase in opioid use. Prior overdose was significantly correlated with anticipating no change in subsequent opioid use pattern (p=0.02). 99% of patients reported that their rapport with their health-care provider would be enhanced if offered an intranasal naloxone rescue kit. As for providers, 24% had completed naloxone rescue kit training, and 96% were able to properly identify its clinical application. 50% of providers felt naloxone access would decrease the likelihood of an overdose occurring, and 58% felt it would not contribute to high-risk behavior. Among providers, completion of naloxone training was correlated with increased awareness of where to access kits for patients (p<0.001). This study suggests that patients and providers have distinct beliefs and attitudes toward overdose prevention. Patient-Provider discussion of overdose prevention enhances patients' rapport with providers. However, access to an intranasal naloxone rescue kit may make some patients more vulnerable to high-risk behavior. Future research efforts examining provider and patient beliefs and practices are needed to help develop and implement effective hospital-based opioid overdose prevention strategies.