The Emergency Department as an Opportunity for Naloxone Distribution.

Abstract

Introduction:Substance 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. Methods:We 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. Results:Of 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. Conclusion:This 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.

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Citation

Published Version (Please cite this version)

10.5811/westjem.2018.8.38829

Publication Info

Gunn, Alexander H, Zachary PW Smothers, Nicole Schramm-Sapyta, Caroline E Freiermuth, Mark MacEachern and Andrew J Muzyk (2018). The Emergency Department as an Opportunity for Naloxone Distribution. The western journal of emergency medicine, 19(6). pp. 1036–1042. 10.5811/westjem.2018.8.38829 Retrieved from https://hdl.handle.net/10161/17825.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Gunn

Alex Gunn

House Staff
Schramm-Sapyta

Nicole Lewellyn Schramm-Sapyta

Associate Professor of the Practice in the Duke Institute for Brain Sciences

Dr. Schramm-Sapyta earned her bachelor’s degree in Biochemistry from N.C. State University in 1994 and her doctoral degree in Pharmacology from Vanderbilt University in 2000.  She is currently an associate professor of the practice and Associate Director of the Duke Institute for Brain Sciences.  She has a long-standing interest in the neurobiology of drug addiction, using rodent models to investigate adolescent vulnerability to addiction. Her scientific expertise in this area supports her passion to bring scientific and clinical knowledge to inform public policy and educate the public about mental health and addiction.  Her course offerings at Duke include “Drugs and the Law,” “Reward and Addiction,” and “Biological Bases of Behavior.”  She co-leads a Bass Connections team on the subject of “Mental Health and the Justice System in Durham County” and is Faculty Advisor to the Wellness Living and Learning Community. 
Her early career was dedicated to exploring the biological basis of drug addiction using rodent behavioral models, with a particular interest in adolescent vulnerability to addiction. This work led her to appreciate the importance of resilience and mental health in individuals and society as a whole, and the role the public policy can play in this area. 

Freiermuth

Caroline Freiermuth

Assistant Professor of Surgery
Muzyk

Andrew Muzyk

Associate Professor of the Practice of Medical Education

Dr. Andrew Muzyk is an Associate Professor of the Practice of Medical Education at Duke University School of Medicine in Durham, NC and an Associate Professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences in Buies Creek, NC. Dr. Muzyk also holds a Clinical Associate appointment in the Duke University School of Nursing. Dr. Muzyk's responsibilities include teaching students across numerous health professions programs, rounding as a clinical pharmacist at Duke University Hospital, and conducting educational research.

Teaching
Dr. Muzyk is the director of pharmacology content and the course co-adminstrator for the Foundations of Patient Care II course, a semester long course that includes pharmacology, pathology, microbiology, immunology, and clinical medicine content. He teaches pharmacology to first-year medical students at Duke University School of Medicine with a focus on CNS medications. For five years, Dr. Muzyk served as the director for the Biological Psychiatry course for psychiatry residents in the Duke Department of Psychiatry and Behavioral Sciences.

At Campbell University College of Pharmacy and Health Sciences, he teaches pharmacy students about the treatment of psychiatric and substance use disorders and men's health. Dr. Muzyk is the course co-coordinator for the pharmacoepidemiology, health informatics, and neurology-psychiatry modules. He precepts fourth-year pharmacy students completing an internal medicine or psychiatry clerkship at Duke University Hospital.

He teaches students in other health professions programs at Duke and Campbell including doctor of osteopathy, physician assistant, and nursing. His teaching in these programs focuses on the management of psychiatric and substance use disorders. Dr. Muzyk serves as a mentor for graduate students enrolled in the University of Michigan Master of Health Professions Education program.

Clinical
Dr. Muzyk's clinical responsibilities include rounding at Duke University Hospital on the Medicine-Psychiatry inpatient service and providing consultation to the inpatient psychiatry unit and the opioid use disorder consult service. He is a clinical pharmacist in the Duke University Hospital Department of Pharmacy.

Research
Dr. Muzyk has over 70 publications from research projects focused on health professions student education and hospital based medication outcomes. His work has been published in journals including Academic Medicine, Substance Abuse, Psychosomatics, Academic Psychiatry, American Journal of Pharmaceutical Education, CNS Drugs, and Pharmacotherapy. He has received approximately $170,000 in grants to support his educational research developing an interprofessional substance use disorder course for health professions students and continuing education programs for healthcare professionals. Educational research support has come from Duke Academy for Health Professions Education and Academic Development, Duke Division of Addiction Medicine, Duke Bass Connections, the Josiah Charles Trent Memorial Foundation Endowment Fund, Duke-Southern Regional Area Health Education Center, and Campbell University College of Pharmacy and Health Sciences. Dr. Muzyk has given numerous presentations throughout the United States on topics related to psychiatric and substance use disorders and health professions education. He is a speaker for the North Carolina Area Health Education Centers (AHEC).

Awards 
Campbell University College of Pharmacy and Health Sciences Dean's Award for Excellence in Teaching; Association of American Medical Colleges (AAMC) Curricular Innovation Award (2020); Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA), New Educator/Investigator award (2019); Campbell University College of Pharmacy and Health Sciences, Educator of the Year (2018); Duke University Hospital Department of Pharmacy, Educator and Researcher of the Year (2018); Duke Academy for Health Professions Education and Academic Development (Duke AHEAD), Interprofessional Excellence Award (2016); the Association of Academic Psychiatry (AAP), Psychiatric Education Award (2012); and, the North Carolina Association of Pharmacist (NCAP), Distinguished Young Pharmacist Award (2012).


Education
Dr. Muzyk received his Doctor of Pharmacy (PharmD) degree from Mercer University College of Pharmacy in Atlanta, GA. He completed two years of post-doctorate pharmacy residency training at DCH Health System in Tuscaloosa, AL and at UNC Medical Center in Chapel Hill, NC. His second year of residency training was focused on psychiatric pharmacy practice. Dr. Muzyk obtained a Master of Health Profession Education degree from University of Michigan. In 2023, he completed a year long Climate Health Organizing Fellowship through the Center for Health Equity Education and Advocacy at Harvard Medical School and Cambridge Health Alliance.




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