Abstract
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.
Keywords
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Article Info
Publication History
Published online: November 10, 2020
Accepted:
October 29,
2020
Received in revised form:
October 19,
2020
Received:
August 10,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
