Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: a retrospective chart review

Abstract

Background Overdose deaths can be prevented by distributing take home naloxone (THN) kits. The emergency department (ED) is an opportune setting for overdose prevention, as people who use opioids frequently present for emergency care, and those who have overdosed are at high risk for future overdose death. We evaluated the implementation of an ED-based THN program by measuring the extent to which THN was offered to patients presenting with opioid overdose. We analyzed whether some patients were less likely to be offered THN than others, to identify areas for program improvement. Methods We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN. Results Among the 342 ED visits for opioid overdose, THN was offered in 49% ( n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97). Conclusions In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.

Addressing co-occurring public health emergencies: The importance of naloxone distribution in the era of COVID-19

“…parks, buildings) where outreach is often conducted. These complications underscore the need for continued support in naloxone distribution across communities and amongst first responders, particularly as uptake of THN has been associated with having previously experienced an overdose, drug use injection, and being linked with harm reduction services (Farrugia et al, 2019;Goldman-Hasbun et al, 2017;O'Brien, Dabbs, Dong, Veugelers & Hyshka, 2019).…”

Opioid Use Disorder Treatment Disruptions during the COVID-19 Pandemic and Other Disasters: A Scoping Review Addressing Dual Public Health Emergencies

“…At a provincial level, systems can embrace harm reduction and contextually tailored care with decriminalization of people who use substances (15,36) and clinical guidelines for safe supply (25) that systemically addresses stigma. Collaboration across systems to link patients with individualized health care and social supports is also needed (37). Public health as a discipline should advance new ways of interacting across services and systems whilst encouraging providers to view their actions as one component of many that create a system accountable to patient needs during disasters and usual care interactions.…”

Anual Evaluation of “Drug Poisonings, Emergency Service” Studies Published in Pubmed 01.01.2019-01.01.2020

“…ED staff use illegal opioids or use a serious overdose because you can potentially benefit from THN, but may miss others who are at high risk for the future, overdose. Hospital EDs, all eligible people Patients at risk of overdose can access THN (33).…”