TY - JOUR
T1 - Naloxone provision to emergency department patients recognized as high-risk for opioid use disorder
AU - Lane, Bennett H.
AU - Lyons, Michael S.
AU - Stolz, Uwe
AU - Ancona, Rachel M.
AU - Ryan, Richard J.
AU - Freiermuth, Caroline E.
N1 - Funding Information:
Drs. Lyons and Freiermuth received research funding support from Brighview Foundation LLC . Cincinnati OH 45206 USA to evaluate the implementation of a county wide naloxone distribution program, utilizing medication donated from Adapt Pharma. Funding sources had no role in conduct of research or preparation of manuscript.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Introduction: Patients with opioid use disorder (OUD) are at increased risk for overdose and death. Clinical practice guidelines and professional organization policy statements recommend providing naloxone to patients at risk for overdose. We sought to characterize fidelity to naloxone practice recommendations in a cohort of Emergency Department (ED) patients in whom opioid use disorder was suspected by the treating physician. Methods: This single-center cross-sectional study evaluated electronic health records from an urban academic ED with 73,000 annual encounters in a region with a high prevalence of OUD. Patients ≥18 years old with encounters from January 1, 2018 to November 30, 2019 were included if discharged from the ED and either administered buprenorphine in the ED or referred to outpatient substance use treatment. The primary outcome measure was the percentage of included patients provided naloxone (take-home or prescription). We used random effects multivariable logistic regression (accounting for multiple patient encounters) to estimate the odds ratio (OR) for receiving naloxone. Results: Of 1036 eligible patient encounters, 320 resulted in naloxone provision (30.9%, 95% CI: 28.1–33.8). Naloxone provision occurred for 33.6% (95% CI 30.5–36.7) of 900 patients referred to outpatient substance use treatment without ED buprenorphine administration, 10.6% (95% CI 5.0–19.2) of 85 patients administered buprenorphine and not referred to outpatient substance use treatment, and 17.6% (95% CI 8.4–30.9) of 51 patients administered buprenorphine and referred to outpatient treatment. After controlling for age, sex, race, and prior provision of naloxone, the administration of buprenorphine was associated with a 94% lower odds (aOR = 0.06 [95% CI 0.011–0.33]) for naloxone provision compared to those only referred to outpatient treatment. Conclusion: A majority of ED patients who received an intervention targeted at OUD, in an ED where take-home naloxone is freely available, did not receive either take-home naloxone or a prescription for naloxone at discharge. Patients receiving buprenorphine were less likely to receive naloxone than patients only referred to outpatient treatment. These data suggest barriers other than recognition of potential OUD and naloxone availability impact provision of naloxone and argue for a treatment “bundle” as a conceptual model for care of ED patients with suspected OUD.
AB - Introduction: Patients with opioid use disorder (OUD) are at increased risk for overdose and death. Clinical practice guidelines and professional organization policy statements recommend providing naloxone to patients at risk for overdose. We sought to characterize fidelity to naloxone practice recommendations in a cohort of Emergency Department (ED) patients in whom opioid use disorder was suspected by the treating physician. Methods: This single-center cross-sectional study evaluated electronic health records from an urban academic ED with 73,000 annual encounters in a region with a high prevalence of OUD. Patients ≥18 years old with encounters from January 1, 2018 to November 30, 2019 were included if discharged from the ED and either administered buprenorphine in the ED or referred to outpatient substance use treatment. The primary outcome measure was the percentage of included patients provided naloxone (take-home or prescription). We used random effects multivariable logistic regression (accounting for multiple patient encounters) to estimate the odds ratio (OR) for receiving naloxone. Results: Of 1036 eligible patient encounters, 320 resulted in naloxone provision (30.9%, 95% CI: 28.1–33.8). Naloxone provision occurred for 33.6% (95% CI 30.5–36.7) of 900 patients referred to outpatient substance use treatment without ED buprenorphine administration, 10.6% (95% CI 5.0–19.2) of 85 patients administered buprenorphine and not referred to outpatient substance use treatment, and 17.6% (95% CI 8.4–30.9) of 51 patients administered buprenorphine and referred to outpatient treatment. After controlling for age, sex, race, and prior provision of naloxone, the administration of buprenorphine was associated with a 94% lower odds (aOR = 0.06 [95% CI 0.011–0.33]) for naloxone provision compared to those only referred to outpatient treatment. Conclusion: A majority of ED patients who received an intervention targeted at OUD, in an ED where take-home naloxone is freely available, did not receive either take-home naloxone or a prescription for naloxone at discharge. Patients receiving buprenorphine were less likely to receive naloxone than patients only referred to outpatient treatment. These data suggest barriers other than recognition of potential OUD and naloxone availability impact provision of naloxone and argue for a treatment “bundle” as a conceptual model for care of ED patients with suspected OUD.
KW - Emergency medicine
KW - Naloxone
KW - Narcotics
KW - Opioid use disorder
KW - Public health
KW - Substance-related disorders
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U2 - 10.1016/j.ajem.2020.10.061
DO - 10.1016/j.ajem.2020.10.061
M3 - Article
C2 - 33243535
AN - SCOPUS:85096855723
SN - 0735-6757
VL - 40
SP - 173
EP - 176
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -