Access and Barriers to Take-Home Naloxone Use among Emergency Department Patients with Opioid Misuse in Baltimore, Maryland, USA

Hurt, Brenten R.; Hussain, Atizaz; Aledhaim, Ali; Moayedi, Siamak; Schenkel, Stephen M.; Kim, Hong

doi:10.1080/10826084.2020.1797811

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Included studies utilized a range of study designs with retrospective chart reviews (n = 14) [23][24][25][26][27][28][29][30][31][32][33][34][35][36] being the most common, followed by randomized controlled trials (n = 10) [37][38][39][40][41][42][43][44][45][46], cross-sectional designs (n = 10) [47][48][49][50][51][52][53][54][55][56], case reports (n = 9) [57][58][59][60][61][62][63][64][65], qualitative studies (n = 5) [66-70], mixed methods studies (n = 5) [71][72][73][74][75], prospective cohort design (n = 2) [76,…”

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

“…• Lack of case management when addressing complex psychosocial illnesses [29] • Insurance status [30,66] • Lack of organizational prioritization [70] • Unengaged and remote hospital leadership [70] • Poor interdepartmental communication, collaboration, and coordination [70] • Poor community-hospital partnerships [70] • Absence of local champion [70] • Rural and community hospitals had structural barriers to follow-up treatments [29,32] • COVID 19 initiated closures and decreased intakes to addiction treatment programs creating barriers to care for treatment seeking patients [32] • Screening impacted by patient trauma [80] • Timely identification of patients [62,69] • No systematic approach to selecting clients for program and inability to select clients based on potential future alcohol/drug use [64] • Phones not available in in all treatment areas [81] • Adaptability of intervention [70] • Trained patients forgetting naloxone kits at discharge; only patient who received training used their kits [49,57] • Covering the cost of and sourcing naloxone kits [54,66,70] • Challenges related to documenting the prescribing, dispensing, and training of naloxone distribution [48,53,54,57].…”

Section: System and Organizational Factors: Reported Barriers Of Impl...mentioning

confidence: 99%

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Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Crowther,

Curran,

Somerville

et al. 2023

PLoS ONE

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Background People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. Methods A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. Findings The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. Conclusion This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.

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Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

Section: System and Organizational Factors: Reported Barriers Of Impl...mentioning

confidence: 99%

Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Crowther,

Curran,

Somerville

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…While the perception of need was the most common reason for declining naloxone (57.5%), the acceptance rate correlated with both the number of risk factors and the Opioid Risk Tool score, suggesting that patients may understand their need. 100 Studies conducted among eligible emergency department patients reported acceptance rates of 64.1% 101 and 68.2%, 102 while an 87.3% 103 rate was obtained when the take-home naloxone was offered at the point of care. Lastly, a 73% naloxone acceptance rate was reported among risk-prioritized outpatient veterans in a single-attempt, telephone-based outreach.…”

Section: To What Extent Is the Attitude Toward Naloxone Affected By T...mentioning

confidence: 99%

Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder?

Adeosun

2022

Journal of Pharmacy Practice

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The United States opioid epidemic is fueled by illicit opioid abuse and prescription opioid misuse and abuse. Consequently, cases of opioid use disorder (OUD, opioid addiction), opioid overdose, and related deaths have increased since the year 2000. Naloxone is an opioid antagonist that rapidly reverses opioid intoxication to prevent death from overdose. It is one of the major risk mitigation strategies recommended in the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain. However, despite the exponential increase in dispensing and distribution of naloxone, opioid overdose and related deaths have continued to increase; suggesting that the increased naloxone supply still lags the need. This discordance is attributed at least in part to the negative attitude toward naloxone, which is based on the belief that naloxone is only meant for “addicts” and “abusers” (OUD patients). This negative attitude or so-called naloxone stigma is therefore considered a major barrier for naloxone distribution and consequently, overdose-death prevention efforts. This article presents evidence that challenges common assertions about OUD stigma being the sole and direct driving force behind naloxone stigma, and the purported magnitude of the barrier that naloxone stigma constitutes for naloxone distribution programs among the stakeholders (patients, pharmacists, and prescribers). The case was then made to operationalize and quantify the construct among the stakeholders to determine the extent to which OUD stigma drives naloxone stigma, and the relative impact of naloxone stigma as a barrier for naloxone distribution efforts.

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A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services

Knaub

Evans

Yang

et al. 2022

Drug and Alcohol Dependence

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Access and Barriers to Take-Home Naloxone Use among Emergency Department Patients with Opioid Misuse in Baltimore, Maryland, USA

Cited by 4 publications

References 21 publications

Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Stigma by Association: To what Extent is the Attitude Toward Naloxone Affected by the Stigma of Opioid Use Disorder?

A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services

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