Study Objectives: Opioid overdose is a significant cause of morbidity and mortality in the United States. For decades, peer-led harm reduction organizations have prevented overdoses through provision of naloxone, an opioid antagonist, directly to those at highest risk of overdose after training them in overdose emergency response. More recently, some emergency departments (EDs) have started similar programs, but take-home naloxone from EDs has yet to become widespread. Common barriers to implementation include limited clinician time, lack of exposure to harm reduction, and uncertainty about liability. In this study we implemented a take-home naloxone program in a moderate-volume, suburban ED in which volunteer naloxone-certified medical students, who were experienced staff members at a local needle exchange, provided overdose prevention education to patients identified as being potentially high-risk for opioid overdose. The program aimed to determine whether involvement of community harm reductionists could initiate overdose prevention and naloxone distribution practices with minimal change or impact to ED throughput. Method(s): Patients were screened by emergency physicians and needle exchange staff for risk of opioid overdose on the basis of their chief complaint, triage intake, and emergency physician impression. Those who met screening criteria were approached by needle exchange staff, who explained the program and inquired about opioid use. Eligible and consenting patients were then trained by the needle exchange staff in the recognition of opioid overdoses, basic emergency response, and naloxone usage. Upon completion of training, the treating physician prescribed naloxone which could be filled by the patient after discharge. Multiple attempts to contact patients were made at 3 months after discharge to identify any barriers to obtaining or using the prescribed naloxone. Result(s): 71 patients met screening criteria. Of these, 24 (34%) were trained and prescribed naloxone. For the remaining 47 (66%), 17 (36%) denied opioid use, 11 (23%) declined participation, 2 (4%) already possessed naloxone, 1 (2%) clinically deteriorated, and 16 (34%) met enrollment criteria but the treating clinician refused to prescribe naloxone. All enrolled patients completed training without issues. At 3-month follow-up, 7 (29%) of patients given naloxone were successfully contacted. Of these, only 2 (29%) chose to fill their prescription. No patients reported obstacles to obtaining naloxone. Conclusion(s): Partnering with community harm reduction organizations can facilitate implementation of ED-based take-home naloxone programs. As this approach has minimal impact on the ED, this may be a useful low-threshold step towards incorporating more robust harm reduction practices in the ED. Obstacles include overcoming physician resistance to prescribing naloxone and inability to directly provide naloxone to patients on discharge. Future programs should consider engaging with physician concerns early and frequently to encourage participation in the program and discuss with pharmacy staff methods to provide patients with naloxone before discharge.
Barbour, K., McQuade, M., Somasundaram, S., & Chakravarthy, B. (2017). 431 Facilitating an Emergency Department Take-Home Naloxone Program Through Involvement of Community-Based Harm Reductionists. Annals of Emergency Medicine, 70(4), S168. https://doi.org/10.1016/j.annemergmed.2017.07.310