In spite of the rising number of opioid-related fatalities and the recently updated recommendations from the American Society of Addiction Medicine (ASAM), naloxone is carried by only a fraction of people who could benefit from it.1,2 In 2021, a study was published showing that fewer than 4% of patients dispensed a high-dose opioid went home with naloxone.2 Lack of naloxone awareness and/or training may be partly to blame for its underutilization, but stigma is more likely the culprit.2-5
Stigma deters the prescribing and dispensing of naloxone
Some healthcare professionals cite logistical barriers to prescribing naloxone, such as lack of time and/or resources to train patients.4 For many healthcare professionals, however, stigma gets in the way of prescribing.3,4
A few themes emerged in the research:
- Fear of offending patients.3,4
Some are concerned about how a conversation about naloxone could impact the patient-provider relationship:3
“I think it might ruin a relationship even knowing the background of somebody, but you don’t want to step over those boundaries where you would ruin a relationship, then they will go out and talk to their friends, ‘Oh, she thinks I’m an addict.’”
Others don’t want to make patients feel uncomfortable:4
“I feel that patients would be almost offended, like, oh, you’re singling me out and I’m cherry picked to do this.”
- Perceiving naloxone as a “moral hazard.”3-5
Some see naloxone as a safety net that encourages reckless opioid use:4
“One of the concerns I would have was does that give them license to just party away and expect a friend to save their life and they just go to the edge? Are they going to take more risk?”
(The reality, however, is that naloxone access does not appear to encourage increased substance use or intensify the risk of overdose.6)
Stigma keeps patients from asking for (or carrying) naloxone
Lack of awareness, lack of knowledge and misinformation are common reasons why many people do not ask their healthcare providers for naloxone.3,4 Yet those who are aware that naloxone is available may still be reluctant to inquire about it.3-5,7
Themes in the research include:
- Perceiving naloxone as a “moral hazard.”3-5
Some worry that asking for naloxone could change their healthcare providers’ attitudes toward them:3
“I think that if you go to the pharmacist and let them know you are picking up an opioid and you would bring it up that you are interested in getting [naloxone], to me red flags automatically go up in that pharmacist’s mind. ‘Why do you want [naloxone]? Do you think you are going to overdose?’”
- Desire to dissociate from the drug-user identity.7
Former opioid users may be reluctant to carry naloxone because it is a reminder of the lifestyle they are trying to leave behind:7
“Me carrying it [naloxone] is making me feel like I’m going to be hanging out with people that are doing it [using drugs].”
- Unintended consequences of obtaining and carrying naloxone.3-5
Some worry that carrying naloxone could lead others to assume they are an active substance user. This could result in unwanted attention from law enforcement, or a loss of housing or other services.3-5
“Then all of a sudden there you are the criminal again.” 3
“I know that some people are afraid … of (other) people discovering their naloxone, and that will out them as an opioid user…”8
Naloxone stigma is a public health hazard
According to the Centers for Disease Control and Prevention, naloxone saves lives.9 Meanwhile, the ASAM is calling for expanded naloxone access.1 In spite of support from these national organizations, however, the stigma surrounding naloxone continues to be a barrier.3-7
Carrying Kloxxado® shows you care
To overcome the stigma associated with naloxone, we must reframe what naloxone symbolizes.10 Carrying a naloxone product such as Kloxxado® (naloxone HCl) nasal spray 8 mg shows that we care about the safety of others.10-12 It also represents a way to support and protect the well-being of people who continue to suffer with substance use disorder (SUD).10
To learn more, follow the links below:
- Words matter: How to talk about substance use disorder (SUD)
- Who can benefit from carrying Kloxxado®?
- Why Kloxxado® should be your naloxone
Kloxxado® is a trademark of Hikma Pharmaceuticals USA Inc.
Please see the Full Prescribing Information and Medication Guide for Kloxxado® for complete product details.
NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see the References below.
- Use of Naloxone for the Prevention of Opioid Overdose Deaths (Public Policy Statement). American Society of Addiction Medicine website. Available at: https://www.asam.org/advocacy/public-policy-statements/details/public-policy-statements/2021/08/09/use-of-naloxone-for-the-prevention-of-drug-overdose-deaths. Accessed October 3, 2022.
- Guy GP, Strahan AE, Jones CM. Concurrent Naloxone Dispensing Among Individuals with High-Risk Opioid Prescriptions, USA, 2015-2019. J Gen Intern Med. 2021;36(10):3254-3456.
- Green TC, et al. Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. J Am Pharm Assoc. 2017;57:S19-S27.
- Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM. Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff. J Gen Intern Med. 2015;30(12):1837-1844.
- This Overdose-Reversal Medicine Could Reduce Opioid Deaths—So Why Don’t More People Carry It? Journal of Emergency Medical Services website. Available at: https://www.jems.com/patient-care/why-dont-more-people-carry-naloxone/. Accessed October 3, 2022.
- Tse WC, et al. Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’ associated with naloxone supply. Int J Drug Policy. 2022;100:103513.
- Bowles JM, et al. “I wanted to close the chapter completely… and I feel like that [carrying naloxone] would keep it open a little bit”: Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity. Int J Drug Policy. 2021;94:103200.
- Bennett AS, Freeman R, Des Jarlais DC, Aronson ID. Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study. JMIR Form Res. 2020;4(12):e22411.
- Lifesaving Naloxone. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/stopoverdose/naloxone/index.html. Accessed October 10, 2022.
- Carrying Naloxone Can Save Lives but Newly Abstinent Opioid Users Resist. UC San Diego Today website. Available at: https://today.ucsd.edu/story/carrying-naloxone-can-save-lives-but-newly-abstinent-opioid-users-resist. Accessed October 3, 2022.
- Kloxxado® (naloxone HCl) Nasal Spray [prescribing information]. Columbus, OH: Hikma Specialty USA Inc., 2021