Disparities in naloxone prescriptions in a University Hospital during the COVID-19 pandemic

Abstract

Background Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. The objective of this study was to characterize the naloxone prescribing rate in patients with opioid use disorder (OUD) at the University of Alabama at Birmingham Hospital in 2019 and 2020. Methods A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020. Naloxone prescribing, defined as either a written prescription or a provided take-home kit, was assessed for all patients with OUD. Results In 2019, 11,959 visits were made by 2962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020; 609 naloxone prescriptions were provided in 2019 (5.1%) and 619 in 2020 (5.3%). In both years, most OUD-related visits and naloxone prescriptions were from and to male, white, individuals. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (33.2% vs 44.3%, p < 0.05), and more OUD patients were admitted to inpatient settings (26.0% vs 31.2%, p < 0.05) and received more naloxone prescriptions in the inpatient setting (46.3% vs 62.0%, p < 0.05) in 2020. The proportion of frequent users (i.e., visits ≥ 4 times/year) increased in 2020 for the emergency department (21.5% vs 26.4%, p < 0.001) and inpatient setting (24.9% vs 28.6%, p = 0.03). Conclusions Our findings indicate the need for improving naloxone awareness in providers and prescribing for patients with OUD, particularly in emergency department and outpatient settings. Our results also demonstrated a disparity in naloxone prescribing; a disproportionate number of opioid-related emergency department visits and overdose deaths were noted in Black people and frequent users.

Naloxone prescriptions among patients with a substance use disorder and a positive fentanyl urine drug screen presenting to the emergency department

“…Previous studies have found disparities in naloxone prescribing among patients of color [8][9][10][11][12]. Initially, our findings were similar, but after adjusting for confounding variables this difference was no longer statistically significant.…”

“…For those with a current diagnosis of OUD and a presumptive positive UDS for fentanyl the rate was 8.7%. These rates are lower than previous studies [8][9][10][11][12], despite our study including patients that also had a presumptive positive UDS for fentanyl. The rates were also lower despite our study including visits that occurred after the expansion of the CDC's overdose awareness campaign [20] in 2019 and the FDA's recommendation for naloxone that was released in July 2020 [4].…”

“…Multiple studies have investigated the rate of naloxone prescription to patients with an OUD who visit the ED [8][9][10][11][12]. However, these studies included only OUD, none included patients with a non-opioid substance use disorder (SUD).…”