Evaluating disparities in prescribing of naloxone after emergency department treatment of opioid overdose

Weiner, Scott G.; Carroll, Aleta D.; Brisbon, Nicholas M.; Rodriguez, Claudia P.; Covahey, Charles; Stringfellow, Erin; DiGennaro, Catherine; Jalali, Mohammad S.; Wakeman, Sarah E.

doi:10.1016/j.jsat.2022.108785

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…Likewise, we found that patients with Hispanic ethnicity were less likely than non-Hispanic patients to have SL. This finding mirrors other recent work we did at our health system that discovered that Hispanic patients were more likely to be provided with a prescription for naloxone after treatment for opioid overdose than non-Hispanic patients 40 . Other patient-level factors—such as being single or divorced compared to married, less educated compared to higher degrees of education, with Medicaid or Medicare insurance compared with commercial, and being a veteran—were all associated with increased presence of SL.…”

Section: Discussionsupporting

confidence: 82%

“…This finding mirrors other recent work we did at our health system that discovered that Hispanic patients were more likely to be provided with a prescription for naloxone after treatment for opioid overdose than non-Hispanic patients. 40 Other patient-level factorssuch as being single or divorced compared to married, less educated compared to higher degrees of education, with Medicaid or Medicare insurance compared with commercial, and being a veteran-were all associated with increased presence of SL. These findings highlight the intersectionality between substance use, stigma, and social determinants of health and should serve as important reminders to clinical staff to assess their biases and be aware of how words used may affect these populations.…”

Section: Discussionmentioning

confidence: 97%

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The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

Weiner

Carroll

et al. 2023

J Addict Med

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Objective: The language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient-and provider-level differences. Methods: All free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse's "Words Matter" list was developed to identify use of SL in context. Results: There were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were "abuse" and "substance abuse." Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11-1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50-0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36-0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80-0.98). Conclusions:The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 97%

The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

Weiner

Carroll

et al. 2023

J Addict Med

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“…12,83 Naloxone prescribing by healthcare providers is low, with fewer than one-half of patients presenting to the ED with opioid overdose being prescribed Naloxone upon discharge. 85 The reason for this underutilization is multifactorial. Barriers to prescribing Naloxone at the time of hospital discharge are cited as time constraints, patient education, provider training, and concern for increased high-risk behaviors.…”

Section: Resultsmentioning

confidence: 99%

Opioids and Youth Athletes

Benjamin,

Perri,

Leemputte

et al. 2024

Sports Health: A Multidisciplinary Approach

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Context: The ongoing opioid epidemic and associated adverse effects impart a large burden on our current healthcare system. The annual economic and noneconomic cost of opioid use disorder and fatal opioid overdose is currently estimated at $1 trillion. Objective: This review presents the prevalence, frequency of use, need, and effectiveness of opioid analgesia in the youth and adolescent athlete population. It identifies current indications for opioid versus nonopioid analgesic use in the setting of acute orthopaedic injuries, postoperative management, concussion, and chronic pain. Current knowledge of youth athlete opioid use, risks related to use, misuse, diversion, and addiction are reviewed. Data Sources: A PubMed, Medline, and Cochrane Library search was conducted in February 2023 to review opioid pain management strategies in the pediatric athlete population from 2000 to present. Study Selection: Searches were restricted to English language articles and human subjects. Initial reviews of titles and abstracts were performed by all authors and relevant full-text articles were selected. Priority was given to systematic and narrative reviews, meta-analyses, and prospective studies. Study Design: Narrative review. Level of Evidence: Level 3. Data Extraction: First author name, publication year, study design, study country, subject demographics, and data on the frequency, type, and duration of analgesic treatments for musculoskeletal injuries, postsurgical care, chronic pain disorders, and concussion were extracted. Results: Pediatric athletes comprise a high-risk population seeking analgesic relief for injury-related pain. Participation in high school sports is associated with increased risk of opioid use. An average of 28% to 46% of high school athletes have used opioids in their lifetime. Participation in ≥1 high school sport puts adolescents at 30% greater odds of future opioid misuse. Conclusion: The use of opioids in the pediatric athlete population is common and associated with both short- and long-term risks of misuse and addiction.

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“…Previous studies have found disparities in naloxone prescribing among patients of color [ 8 – 12 ]. Initially, our findings were similar, but after adjusting for confounding variables this difference was no longer statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have investigated the rate of naloxone prescription to patients with an OUD who visit the ED [8][9][10][11][12]. However, these studies included only OUD, none included patients with a non-opioid substance use disorder (SUD).…”

Section: Introductionmentioning

confidence: 99%

Naloxone prescriptions among patients with a substance use disorder and a positive fentanyl urine drug screen presenting to the emergency department

Ali,

Shell,

Harris

et al. 2023

Harm Reduct J

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Background Over 109,000 people in the USA died from a drug overdose in 2022. More alarming is the amount of drug overdose deaths involving synthetic opioids other than methadone (SOOM), primarily fentanyl. From 2015 to 2020, the number of drug overdose deaths from SOOM increased 5.9-fold. SOOM are commonly being found in many other drugs without the user's knowledge. Given the alarming number of overdose deaths from illicit drugs with SOOM, naloxone should be prescribed for all persons using illicit drugs regardless of if they knowingly use opioids. How often providers prescribe naloxone for these patients remains unknown. The aim of this study is to determine the rate of naloxone prescriptions given to patients with any substance use disorder, including when the patient has a urine drug screen positive for fentanyl. Secondary aims include determining what patient factors are associated with receiving a naloxone prescription. Methods The design was a single-center retrospective cohort study on patients that presented to the Augusta University Medical Center emergency department between 2019 through 2021 and had an ICD-10 diagnosis of a substance use disorder. Analyses were conducted by logistic regression and t-test or Welch’s t-test. Results A total of 10,510 emergency department visits were by 6787 patients. Naloxone was prescribed in 16.3% of visits with an opioid-related discharge diagnosis and 8.4% of visits with a non-opioid substance use-related discharge diagnosis and a urine drug screen positive for fentanyl. Patients with a fentanyl positive urine drug screen had higher odds of receiving a naloxone prescription (aOR 5.80, 95% CI 2.76–12.20, p < 0.001). Patients with a psychiatric diagnosis had lower odds of being prescribed naloxone (aOR 0.51, p = 0.03). Patients who received naloxone had a lower number of visits (mean 1.23 vs. 1.55, p < 0.001). Patients with a urine drug screen positive for cocaine had higher odds of frequent visits (aOR 3.07, p = 0.01). Conclusions Findings should remind providers to prescribe naloxone to all patients with a substance use disorder, especially those with a positive fentanyl urine drug screen or a co-occurring psychiatric condition. Results also show that cocaine use continues to increase healthcare utilization.

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Evaluating disparities in prescribing of naloxone after emergency department treatment of opioid overdose

Cited by 10 publications

References 36 publications

The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder

Opioids and Youth Athletes

Naloxone prescriptions among patients with a substance use disorder and a positive fentanyl urine drug screen presenting to the emergency department

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