The Emergency Department as an Opportunity for Naloxone Distribution.

Gunn, Alexander H

Smothers, Zachary PW

Schramm-Sapyta, Nicole

Freiermuth, Caroline E

MacEachern, Mark

Muzyk, Andrew J

2018-12-29T22:51:47Z

2018-12-29T22:51:47Z

2018-11

2018-12-29T22:51:45Z

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.

wjem-19-1036

1936-900X

1936-9018

https://hdl.handle.net/10161/17825

eng

Western Journal of Emergency Medicine

The western journal of emergency medicine

10.5811/westjem.2018.8.38829

Drug Overdose

Emergency Service, Hospital

Humans

Naloxone

Narcotic Antagonists

Opioid-Related Disorders

Program Evaluation

United States

The Emergency Department as an Opportunity for Naloxone Distribution.

Journal article

Gunn, Alexander H|0000-0001-8912-4867

Muzyk, Andrew J|0000-0002-6904-2466

1036

1042

6

Staff

Duke

Nursing

School of Nursing

Psychiatry & Behavioral Sciences, General Psychiatry

Psychiatry & Behavioral Sciences

Clinical Science Departments

School of Medicine

Institutes and Provost's Academic Units

Duke Institute for Brain Sciences

University Institutes and Centers

Psychiatry & Behavioral Sciences, Addictions

Student

Published

19