Rural Caregivers Prefer 'Bad Reaction' to 'Overdose' When Explanining Opioid Antidote

Study also suggests pharmacists use “EpiPen” analogy to describe naloxone use

Rural caregivers for patients taking prescription opioids are most comfortable using the term “bad reaction” instead of the potentially stigmatizing term “overdose,” and they favor “EpiPen” as the best comparison for describing emergency use of naloxone to reverse effects of opioids, according to a new study scheduled for presentation at the ASHP Midyear Clinical Meeting & Exhibition in Las Vegas.

“Familiarity with caregivers’ terminology preferences for overdose and naloxone improves the ability of healthcare professionals to provide counseling in a comprehensible and culturally sensitive manner,” said Kalynn Hosea, MPH, PharmD candidate at University of North Carolina Eshelman School of Pharmacy and lead research on the study. “Using the words that caregivers tend to favor may increase their understanding of the drug and its uses.”

More than a million people have died from opioid overdose since 2000 — a disproportionate number in rural areas — and 18% of recent opioid deaths involved prescriptions. Naloxone, delivered via injection or nasal spray, saves lives when used to rapidly reverse the impact of opioids during a suspected overdose.

Researchers interviewed 40 rural caregivers in four states who live with someone at risk for opioid overdose and who had purchased naloxone at a pharmacy. The caregivers’ language preferences for describing an overdose varied somewhat by race, with most white and Black participants favoring “bad reaction” and American Indian participants preferring “accidental overdose.” Participants said this language was less stigmatizing or offensive compared to “overdose.”

“The use of stigmatizing language in the healthcare environment is a risk to patient safety and a threat to optimal health,” said Anna Legreid Dopp, PharmD, CPHQ, ASHP senior director of clinical guidelines and quality improvement. “This study provides valuable insights about the rural communities studied and serves as a good reminder of the importance of communicating with patient-centered, non-stigmatizing language when helping patients and caregivers understand medications.”

For naloxone analogies, 64% of participants preferred “EpiPen,” with most finding the term more relevant to the use of naloxone than "fire extinguisher," a term suggested in some pharmacy training programs. EpiPen is the brand name for an auto-injector used to deliver epinephrine for life-threatening allergic reactions. It was also preferred to other word choices such as “lifesaver,” “stick pen,” or “nasal spray.”

Healthcare professionals may initially be uncomfortable with imprecise use of the term EpiPen, but using it as an analogy to create clarity is worthwhile, Hosea said.

“The stigma, misunderstanding and confusion associated with other analogies used to describe naloxone creates communication barriers,” she said.

Despite national and state policies aimed at increasing naloxone access through pharmacies, opioid overdose death rates increased during the COVID-19 pandemic, particularly among Blacks, American Indian and Alaska Natives in rural areas. Caregivers play a crucial role in delivering naloxone to save lives. This is the first study to identify rural caregivers’ overdose and naloxone terminology preferences while exploring differences by race.

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About the ASHP Midyear Clinical Meeting & Exposition

ASHP’s Midyear Clinical Meeting and Exhibition is the largest gathering of pharmacy professionals in the world. Attended by more than 20,000 pharmacy professionals from across the globe, the meeting provides opportunities for professional development, networking, enhancing practice skills, and staying current with the latest products and innovations. Tag and follow ASHP and the meeting on social media, #ASHP22 and @ASHPOfficial.

About ASHP

ASHP is the collective voice of pharmacists who serve as patient care providers in hospitals, health systems, ambulatory clinics, and other healthcare settings spanning the full spectrum of medication use. The organization’s more than 60,000 members include pharmacists, student pharmacists, and pharmacy technicians. For 80 years, ASHP has been at the forefront of efforts to improve medication use and enhance patient safety. For more information about the wide array of ASHP activities and the many ways in which pharmacists advance healthcare, visit ASHP’s website, ashp.org, or its consumer website, SafeMedication.com.