Factors Associated With Participation in an Emergency Department–Based Take-Home Naloxone Program for At-Risk Opioid Users - 19/04/17
, Jane Buxton, MBBS, MHSc c, f, Gray Meckling, BSc d, Amanda Giesler, BSc c, Michelle Lee, BSc, MPH e, Kirsten Fuller, BSc, BScN a, Hong Quian, MSc g, Dalya Marks, PhD h, Frank Scheuermeyer, MD, MHSc a, bAbstract |
Study objective |
Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance.
Methods |
At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance.
Results |
Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as “Indigenous.” Of 201 respondents, 137 (68.2%; 95% confidence interval [CI] 61.7% to 74.7%) accepted take-home naloxone. Multivariable analysis revealed that factors associated with take-home naloxone acceptance included witnessing overdose in others (odds ratio [OR] 4.77; 95% CI 2.25 to 10.09), concern about own overdose death (OR 3.71; 95% CI 1.34 to 10.23), female sex (OR 2.50; 95% CI 1.21 to 5.17), and injection drug use (OR 2.22; 95% CI 1.06 to 4.67).
Conclusion |
A two-thirds ED take-home naloxone acceptance rate in patients using opioids should encourage all EDs to dispense take-home naloxone. ED-based take-home naloxone programs have the potential to improve access to take-home naloxone and awareness in individuals most vulnerable to overdoses.
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| Please see page 341 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: AK and FS conceived the study. AK, JB, and DM designed the study. AK supervised data collection. GM, AG, and ML collected data. KF was the site manager for take-home naloxone distribution and assisted with study operational issues. AK and HQ performed statistical analysis. AK drafted the article, and all authors assisted in critical revisions. AK takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: Ms. Quian's institution received payment for assistance with statistical analyses. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 69 - N° 3
P. 340-346 - mars 2017 Retour au numéro
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