Opioid Overdose Risk Perceptions and Barriers and Facilitators to Naloxone Distribution for Hospitalized Patients Who Use Stimulants: A Qualitative Study of Patients and Clinicians

OBJECTIVES: Most stimulant-related deaths in the United States involve opioids due to intentional or unintentional fentanyl toxicity. It is critical to ensure patients who use nonprescribed stimulants have access to naloxone, and hospitalization is an opportunity to provide this lifesaving medication. We aimed to understand perceptions on opioid overdose risk as well as barriers to and facilitators of take-home naloxone distribution through the perspectives of hospitalized patients who use stimulants and the clinicians who care for them. METHODS: We conducted key-informant interviews with hospitalized patients who use cocaine or methamphetamine and hospital-based, nonaddiction medicine specialized nurses, physicians, and advanced practice providers. We analyzed results using a rapid matrix-based qualitative technique. RESULTS: Thirteen patients and 13 clinicians participated. Themes included: (1) people who use stimulants have personal, traumatic experiences with opioid overdose, even if they do not intentionally use opioids (patients); (2) despite awareness of stimulant adulteration with fentanyl, patients and hospital-based clinicians differ in their perceptions of opioid overdose risk (patients and clinicians); and (3) factors impacting in-hospital naloxone distribution include competing work-related priorities, logistical considerations necessary to ensure patients receive naloxone in-hand before discharge, and the cost of naloxone (clinicians). CONCLUSIONS: Strategies to increase take-home naloxone receipt among hospitalized patients must consider the specific needs of patients who use stimulants, who may view themselves as low-risk for opioid overdose but be open to carrying naloxone for the benefit of others. Clinicians suggested strategies to address logistical considerations of naloxone delivery unique to the hospital environment.