Background
Unintentional overdose involving opioid analgesics is a leading cause of injury-related death in the United States.
Objectives
To evaluate the feasibility and impact of implementing naloxone prescription to patients prescribed opioids for chronic pain.
Design
2-year non-randomized intervention study.
Setting
6 safety net primary care clinics in San Francisco.
Participants
1985 adults receiving long-term opioids for pain.
Intervention
Providers and clinic staff were trained and supported in naloxone prescribing.
Measurements
Outcomes were proportion of patients prescribed naloxone, opioid-related emergency department (ED) visits, and prescribed opioid dose based on chart review.
Results
38.2% of 1,985 patients on long-term opioids were prescribed naloxone. Patients on higher doses of opioids and with a past 12-month opioid-related emergency department (ED) visit were independently more likely to be prescribed naloxone. Patients who received a naloxone prescription had 47% fewer opioid-related ED visits per month six months after the receipt of the prescription (IRR=0.53, 95%CI=0.34–0.83, P=0.005) and 63% fewer visits after one year (IRR=0.37, 95%CI=0.22–0.64, P<0.001), compared to patients who did not receive naloxone. There was no net change over time in opioid dose among those who received naloxone compared to those who did not (IRR 1.03, 95% CI 0.91–1.27, P = 0.61).
Limitations
Results are observational and may not be generalizable beyond safety net settings.
Conclusion
Naloxone can be co-prescribed to primary care patients prescribed opioids for pain. When advised to offer naloxone to all patients on opioids, providers may prioritize those with established risk factors. Providing naloxone in primary care settings may have ancillary benefits such as reducing opioid-related adverse events.
Funding Source
National Institutes of Health grant R21DA036776
Tracking opioid overdose ED visits by diagnostic coding is fairly specific but insensitive, and coding was not influenced by administration of naloxone or the specific opioids involved. The reason for the high rate of missed cases is uncertain, although these results suggest that a more clearly defined case definition for overdose may be necessary to ensure effective opioid overdose surveillance. Changes in coding practices under ICD-10 might help to address these deficiencies.
Aims
To describe characteristics of participants and overdose reversals
associated with a community-based naloxone distribution program and identify
predictors of obtaining naloxone refills and using naloxone for overdose
reversal.
Design
Bivariate statistical tests were used to compare characteristics of
participants who obtained refills and reported overdose reversals, versus
those who did not. We fitted multiple logistic regression models to identify
predictors of refills and reversals; zero-inflated multiple Poisson
regression models were used to identify predictors of number of refills and
reversals.
Setting
San Francisco, California, U.S.A.
Participants
Naloxone program participants registered and reversals reported from
2010-2013.
Measurements
Baseline characteristics of participants and reported characteristics
of reversals.
Findings
2500 participants were registered and 702 reversals were reported
from 2010-2013. Participants who had witnessed an overdose
[AOR=2.02(1.53-2.66); AOR=2.73(1.73-4.30)] or used heroin
[AOR=1.85(1.44-2.37); AOR=2.19(1.54-3.13)], or methamphetamine
[AOR=1.71(1.37-2.15); AOR=1.61(1.18-2.19)] had higher odds of obtaining a
refill and reporting a reversal, respectively. African American [Adjusted
Odds Ratio=0.63(95%CI=0.45-0.88)] and Latino [AOR=0.65(0.43-1.00)]
participants had lower odds of obtaining a naloxone refill whereas Latino
participants who obtained at least one refill reported a higher number of
refills [Incidence Rate Ratio=1.33(1.05-1.69)].
Conclusions
Community naloxone distribution programs are capable of reaching
sizeable populations of high-risk individuals and facilitating large numbers
of overdose reversals. Community members most likely to engage with a
naloxone program and use naloxone to reverse an overdose are active drug
users.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.