Sustainable Naloxone Education and Distribution From an Urban Emergency Department
Manteuffel J, Shayya S, Sabagha N, MacDonald N, Griebe K, Doyal M, Hedroug Y, France J, El-Khoury C, and Theoharris T. 317 Sustainable Naloxone Education and Distribution From an Urban Emergency Department. Ann Emerg Med 2019; 74(4):S124-S125.
Ann Emerg Med
Study Objectives: The opioid epidemic was declared a national emergency in 2017. Naloxone can rapidly reverse fatal overdose and evidence shows reduced mortality when naloxone is available in the community. The optimal naloxone distribution methods are yet to be established. We aim to determine the feasibility and sustainability of instituting a program which provides naloxone in hand to at-risk patients in a high-volume, urban emergency department (ED). Secondary objectives are to describe patient receptiveness to receiving naloxone at ED discharge, medication cost and 30 day follow up. Methods: Our study included a convenience sample of patients who presented to the ED between October 2018 and May 2019 who exhibited improvement in mental status after administration of naloxone, either in the ED or via emergency medical services, and who were anticipated to be discharged home from the ED. Enrollment was limited to the outpatient pharmacy work hours: Monday to Friday 7am to 6pm. Eligible patients were identified by ED personnel and were engaged by the ED naloxone educator 1-2 hours prior to anticipated discharge. Patients were asked if they were interested in receiving the naloxone and the administration instructions. If the patient was agreeable to others receiving education with them, others were invited to participate. If no one was available, teach back occurred to ensure the patient could teach others after discharge. The outpatient pharmacy delivered a 2-dose package of 4mg naloxone nasal spray as prescribed by the ED provider prior to discharge. Uninsured patients had medication cost covered by the ED medical needs fund. The pharmacy provided additional financial assistance for those with copays. The ED naloxone educator provided the naloxone administration education along with an informational packet on community resources and follow-up care. Patients were called in follow-up at least 30 days after the date of visit. Results: A total of 30 patients were approached between October 2018 and May 2019, and 27 (90%) patients were successfully enrolled in the study. The cohort was predominantly African American (75%) with a median age of 54 years and male sex (74%). 24/27 (89%) of patients were insured and 20/24 (83%) insured patients had zero copay for naloxone nasal spray. One of 18 (6%) eligible patients for 30 day follow up was successfully contacted. 4/18 (22%) patients who were agreeable to receive naloxone declined to give contact information for 30-day follow-up. The study was initiated as a 1-month pilot and was continued after ED administration noted minimal interference to ED workflow. Conclusion: Utilization of existing ED systems can allow for a sustainable model of naloxone provision and administration instruction. Most patients in the study had zero copay and were receptive to education. Follow-up in this patient population was relatively unsuccessful. Identifying patients nearing the end of an observation period with an anticipated discharge home can allow for naloxone distribution to cause minimal disruption to workflow in a busy ED. This model of naloxone provision can be sustainable without external funding and provides a method to receive prescribed medications while in the ED. Further studies are needed to demonstrate sustainable naloxone distribution.