The Emergency Department as an Opportunity for Naloxone Distribution

Abstract

IntroductionSubstance use disorders, including opioid use disorders, are a major public health concern in the United States. Between 2005 and 2014, the rate of opioid-related emergency department (ED) visits nearly doubled, from 89.1 per 100,000 persons in 2005 to 177.7 per 100,000 persons in 2014. Thus, the ED presents a distinctive opportunity for harm-reduction strategies such as distribution of naloxone to patients who are at risk for an opioid overdose.MethodsWe conducted a systematic review of all existing literature related to naloxone distribution from the ED. We included only those articles published in peer-reviewed journals that described results relating to naloxone distribution from the ED.ResultsOf the 2,286 articles we identified from the search, five met the inclusion criteria and had direct relevance to naloxone distribution from the ED setting. Across the studies, we found variation in the methods of implementation and evaluation of take-home naloxone programs in the ED. In the three studies that attempted patient follow-up, success was low, limiting the evidence for the programs’ effectiveness. Overall, in the included studies there is evidence that distributing take-home naloxone from the ED has the potential for harm reduction; however, the uptake of the practice remained low. Barriers to implementation included time allocated for training hospital staff and the burden on workflow.ConclusionThis systematic review of the best evidence available supports the ED as a potential setting for naloxone distribution for overdose reversal in the community. The variability of the implementation methods across the studies highlights the need for future research to determine the most effective practices.

Interrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder

“…11,14 Just as the ED is a unique setting to increase rates of BUP initiation, it is also an opportunity to implement other harm reduction strategies such as naloxone prescribing. 15 Numerous patient-side barriers currently limit the adoption of BUP initiation, including confusion and cultural stigma surrounding medication therapy for OUD and patient perceptions that such treatment is harmful, inferior to detoxification, and even incompatible with being truly "drug-free." [16][17][18] The lack of adoption of ED initiation of BUP into routine emergency care has been attributed to emergency clinicians' lack of training in addiction treatment and perception that BUP initiation is unfamiliar, complicated, and timeconsuming.…”

Point-of-sale Naloxone: Novel Community-based Research to Identify Naloxone Availability

“…Pharmacy-based POSN is an evolving harm reduction approach to limit morbidity and mortality from opioid overdose. Collaborative naloxone prescribing has developed in parallel with other models of increasing naloxone availability, including point-of-contact, 17 emergency department-based, 18 and pharmacist-driven distribution. 19 The present study suggests that POSN availability is more widespread in this metropolitan area than it was in 10 New Jersey cities that were assessed by telephone survey.…”

The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study

“…Opioid overdose education typically includes education about overdose risk factors and how to recognize and respond to an overdose, including naloxone administration; training can be provided in a variety of formats including in-person or on-line. Active OEND examples include: syringe service program workers providing OEND to people who inject opioids ( Doe-Simkins et al, 2014 ; Walley et al, 2013b ; Wheeler et al, 2015 ); emergency department staff providing OEND to patients seen for opioid-use complications ( Dwyer et al, 2015 ; Gunn et al, 2018 ); and equipping people released from incarceration with naloxone ( Bird et al, 2016 ; Wenger et al, 2019 ). Passive OEND …”