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Opioid Education and Nasal Naloxone Rescue Kit Distribution in the Emergency Department

2013; Elsevier BV; Volume: 62; Issue: 4 Linguagem: Inglês

10.1016/j.annemergmed.2013.07.171

1097-6760

Kristin Dwyer, Alexander Y. Walley, Amy Sorensen-Alawad, Breanne Langlois, Patricia Mitchell, Shuo Cheng Lin, Josh Cromwell, Sophie Strobel, Edward Bernstein,

Emergency and Acute Care Studies

Study ObjectivesEmergency departments (ED) offer a unique opportunity to address the national opioid overdose epidemic. We describe the first ever ED-based overdose education and nasal naloxone distribution (OEND) program. We aimed to test the feasibility of OEND and determine whether OEND resulted in higher rates of opioid use or overdose (OD), or lower rates of calling 911 during a witnessed OD than overdose education (OE) alone.MethodsThis was a retrospective cohort study of ED patients seen at an academic, urban, Level I trauma center between 1/11-2/12 with opioid abuse who received OE or OEND from designated staff. OE is an intervention to train opioid users and those likely to be bystanders in an OD to prevent, recognize, and respond to an OD (e.g. calling 911, rescue breathing, and administering naloxone). Some patients who were given OE in the ED also received a nasal naloxone rescue kit (OEND). Between 3/12 and 10/12, research assistants used phone numbers from hospital billing data to call these ED patients and conduct a survey of their current substance use, OD risk knowledge recollection, history of witnessed and self-reported personal ODs since their ED index visit, and actions taken during witnessed ODs. We calculated descriptive statistics and chi-square statistics to assess differences between OE and OEND for any 30-day opioid use, self-reported OD, and calling 911.ResultsOf 415 identified subjects, 69 could be reached and 51 completed the phone survey (23 in OE group and 28 OEND group) with a mean follow-up time since ED index visit of 11.8 months. The mean age was 43, 41% female, 57% white, 12% African American, 19% Hispanic. There were no statistically significant differences between the eligible and enrolled subjects demographically. Without prompting, 51% recalled at least 2 key OD risk behaviors (danger of mixing drugs (73%), danger of use after periods of abstinence (31%), and using alone (22%)). Among the 27 who witnessed an OD, 89% performed at least 1 rescue measure: calling 911 (63%), rescue breathing (26%), and successfully administered naloxone (22%). Among all respondents 22% reported an OD since the intervention and 40% reported past 30 day opioid use. We detected no significant differences in OE vs. OEND for 30-day opioid use (35% vs 36%), self-reported overdose since ED visit (26% vs 18%) or calling 911 in a witnessed overdose (64% vs 62%). Some subjects surveyed received nasal naloxone kits at other sites such as detoxification centers since their ED index visit. We performed a separate analysis to compare OE and OEND ALL (naloxone from ED or other location), we discovered that those with nasal naloxone were significantly more likely to perform a life-saving measure in a witnessed overdose (38% vs 84% p<0.05) and 38% vs 74% called 911.ConclusionsParticipants demonstrated retention of risk knowledge and appropriate use of rescue measures for witnessed overdose. Naloxone distribution did not result in higher rates of opioid use or OD, or lower rates of calling 911. In fact, access to nasal naloxone was associated with acting in a witnessed overdose. While this was a pilot study using retrospective methods, it is the first description of an ED-based OD prevention program that includes naloxone distribution and supports the need for further OEND study and implementation efforts in EDs. Study ObjectivesEmergency departments (ED) offer a unique opportunity to address the national opioid overdose epidemic. We describe the first ever ED-based overdose education and nasal naloxone distribution (OEND) program. We aimed to test the feasibility of OEND and determine whether OEND resulted in higher rates of opioid use or overdose (OD), or lower rates of calling 911 during a witnessed OD than overdose education (OE) alone. Emergency departments (ED) offer a unique opportunity to address the national opioid overdose epidemic. We describe the first ever ED-based overdose education and nasal naloxone distribution (OEND) program. We aimed to test the feasibility of OEND and determine whether OEND resulted in higher rates of opioid use or overdose (OD), or lower rates of calling 911 during a witnessed OD than overdose education (OE) alone. MethodsThis was a retrospective cohort study of ED patients seen at an academic, urban, Level I trauma center between 1/11-2/12 with opioid abuse who received OE or OEND from designated staff. OE is an intervention to train opioid users and those likely to be bystanders in an OD to prevent, recognize, and respond to an OD (e.g. calling 911, rescue breathing, and administering naloxone). Some patients who were given OE in the ED also received a nasal naloxone rescue kit (OEND). Between 3/12 and 10/12, research assistants used phone numbers from hospital billing data to call these ED patients and conduct a survey of their current substance use, OD risk knowledge recollection, history of witnessed and self-reported personal ODs since their ED index visit, and actions taken during witnessed ODs. We calculated descriptive statistics and chi-square statistics to assess differences between OE and OEND for any 30-day opioid use, self-reported OD, and calling 911. This was a retrospective cohort study of ED patients seen at an academic, urban, Level I trauma center between 1/11-2/12 with opioid abuse who received OE or OEND from designated staff. OE is an intervention to train opioid users and those likely to be bystanders in an OD to prevent, recognize, and respond to an OD (e.g. calling 911, rescue breathing, and administering naloxone). Some patients who were given OE in the ED also received a nasal naloxone rescue kit (OEND). Between 3/12 and 10/12, research assistants used phone numbers from hospital billing data to call these ED patients and conduct a survey of their current substance use, OD risk knowledge recollection, history of witnessed and self-reported personal ODs since their ED index visit, and actions taken during witnessed ODs. We calculated descriptive statistics and chi-square statistics to assess differences between OE and OEND for any 30-day opioid use, self-reported OD, and calling 911. ResultsOf 415 identified subjects, 69 could be reached and 51 completed the phone survey (23 in OE group and 28 OEND group) with a mean follow-up time since ED index visit of 11.8 months. The mean age was 43, 41% female, 57% white, 12% African American, 19% Hispanic. There were no statistically significant differences between the eligible and enrolled subjects demographically. Without prompting, 51% recalled at least 2 key OD risk behaviors (danger of mixing drugs (73%), danger of use after periods of abstinence (31%), and using alone (22%)). Among the 27 who witnessed an OD, 89% performed at least 1 rescue measure: calling 911 (63%), rescue breathing (26%), and successfully administered naloxone (22%). Among all respondents 22% reported an OD since the intervention and 40% reported past 30 day opioid use. We detected no significant differences in OE vs. OEND for 30-day opioid use (35% vs 36%), self-reported overdose since ED visit (26% vs 18%) or calling 911 in a witnessed overdose (64% vs 62%). Some subjects surveyed received nasal naloxone kits at other sites such as detoxification centers since their ED index visit. We performed a separate analysis to compare OE and OEND ALL (naloxone from ED or other location), we discovered that those with nasal naloxone were significantly more likely to perform a life-saving measure in a witnessed overdose (38% vs 84% p<0.05) and 38% vs 74% called 911. Of 415 identified subjects, 69 could be reached and 51 completed the phone survey (23 in OE group and 28 OEND group) with a mean follow-up time since ED index visit of 11.8 months. The mean age was 43, 41% female, 57% white, 12% African American, 19% Hispanic. There were no statistically significant differences between the eligible and enrolled subjects demographically. Without prompting, 51% recalled at least 2 key OD risk behaviors (danger of mixing drugs (73%), danger of use after periods of abstinence (31%), and using alone (22%)). Among the 27 who witnessed an OD, 89% performed at least 1 rescue measure: calling 911 (63%), rescue breathing (26%), and successfully administered naloxone (22%). Among all respondents 22% reported an OD since the intervention and 40% reported past 30 day opioid use. We detected no significant differences in OE vs. OEND for 30-day opioid use (35% vs 36%), self-reported overdose since ED visit (26% vs 18%) or calling 911 in a witnessed overdose (64% vs 62%). Some subjects surveyed received nasal naloxone kits at other sites such as detoxification centers since their ED index visit. We performed a separate analysis to compare OE and OEND ALL (naloxone from ED or other location), we discovered that those with nasal naloxone were significantly more likely to perform a life-saving measure in a witnessed overdose (38% vs 84% p<0.05) and 38% vs 74% called 911. ConclusionsParticipants demonstrated retention of risk knowledge and appropriate use of rescue measures for witnessed overdose. Naloxone distribution did not result in higher rates of opioid use or OD, or lower rates of calling 911. In fact, access to nasal naloxone was associated with acting in a witnessed overdose. While this was a pilot study using retrospective methods, it is the first description of an ED-based OD prevention program that includes naloxone distribution and supports the need for further OEND study and implementation efforts in EDs. Participants demonstrated retention of risk knowledge and appropriate use of rescue measures for witnessed overdose. Naloxone distribution did not result in higher rates of opioid use or OD, or lower rates of calling 911. In fact, access to nasal naloxone was associated with acting in a witnessed overdose. While this was a pilot study using retrospective methods, it is the first description of an ED-based OD prevention program that includes naloxone distribution and supports the need for further OEND study and implementation efforts in EDs.