Overdose and take‐home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with ‘take‐home naloxone’ in emergency departments

Abstract

Objective Although most unintentional opioid deaths in Australia are attributed to pharmaceutical opioids, take‐home naloxone (THN) programmes have to date predominantly targeted people using illicit opioids in drug treatment and harm reduction settings. We sought to examine the feasibility of delivering THN brief interventions (THN‐BIs) with intranasal naloxone in EDs. Methods This pilot feasibility study was conducted across three major metropolitan EDs in Sydney and Melbourne. ED staff were surveyed about their perspectives regarding THN before completing a 30‐min training programme in THN‐BI delivery. Patients presenting with opioid overdose or considered high risk for future overdose were eligible to receive the THN‐BI. Staff survey responses were compared between hospitals and provider types using one‐way analysis of variances. Patient demographic and clinical characteristics were extracted from medical records and compared between hospitals and overdose type using Fisher's exact test and one‐way analysis of variances. Results One hundred and twenty‐two ED staff completed the survey. One hundred and ten (90.2%) agreed that EDs should provide THN‐BIs, whereas 23 (19.2%) identified time constraints and 17 (12.9%) felt uncomfortable discussing overdose with patients. Fifty‐seven patients received the THN‐BI, with the majority (n = 50, 87.7%) having presented following opioid overdose. The median age was 44 years and 40 (71.4%) were men. Two‐thirds of the overdoses (n = 31, 66.0%) were attributed to heroin with one‐third (n = 16, 34%) being attributed to pharmaceutical opioids. Conclusions ED‐based delivery of THN‐BIs can reach a wide range of individuals at‐risk of overdose. The present study supports the feasibility of THN interventions in EDs and underscores the importance of addressing implementation barriers including staff training.

Mortality in the SuperMIX cohort of people who inject drugs in Melbourne, Australia: a prospective observational study

“…Previous research findings, including those from the SuperMIX cohort [ 21 ], indicate frequent use of health services among people who inject drugs [ 22 ]. Recent self‐reported ambulance and/or emergency department utilization was associated with mortality risk in our study, which accentuates the need to scale up interventions involving these emergency services that aim to reduce future mortality events—such as making take‐home naloxone (THN) available from ambulance services, similar to recent efforts to make THN available through emergency departments [ 23 ], potentially with referrals to community THN providers for follow‐up. Research among broader populations of frequent ambulance attendees [ 24 ] or people who inject drugs who use emergency departments [ 21 ] indicates that reasons for calling emergency services for non‐urgent issues are complex and often misunderstood, and impacted by socio‐economic deprivation and lower income [ 28 ].…”

“…Many studies that investigate mortality in broader populations at risk of opioid overdose, such as opioid‐dependent people and those receiving opioid treatment, link administrative databases of specialist drug treatment [ 11 , 12 , 13 , 14 , 15 ], health [ 10 , 16 , 17 , 18 , 19 , 20 , 21 ] or prison data [ 22 , 23 , 24 ] with mortality records. In these studies, injecting drug use is identified as a key risk factor, as are related issues such as HIV status [ 25 , 26 ], with opioid agonist treatment (OAT) typically protective [ 27 ].…”

Patient perspectives on naloxone receipt in the emergency department: a qualitative exploration

“…US guidelines for ED OUD management have highlighted the importance of naloxone prescribing for those with OUD [16]. Adoption of ED-based naloxone distribution is less common outside North America, although there have been promising pilot programs [37][38][39]. Our findings suggest that while efforts to boost prescribing of naloxone are important, these efforts will be most successful when paired with effective patient education and communication.…”

Is a randomised controlled trial of take home naloxone distributed in emergency settings likely to be feasible and acceptable? Findings from a UK qualitative study exploring perspectives of people who use opioids and emergency services staff

“…Sokol et al reported provider attitudes showed increasing understanding towards opioid users, and a desire to feel that they are making a difference to patients’ lives [ 33 ]. Hawk et al (2022) reported improving attitudes amongst ED staff towards opioid overdose survivors and a survey of staff in Canada and Australia showed around 9/10 of staff supported provision of THN in the ED [ 15 , 18 ])…”