1EMF Take-Home Naloxone Rescue Kits Following Heroin Overdose in the Emergency Department to Prevent Opioid Overdose-Related Repeat Emergency Department Visits, Hospitalization, and Death: A Pilot Study

Abstract

The United States is facing an epidemic of drug overdose deaths of unprecedented scale. Since 2000, our nation has seen a 137% increase in overdose-related death, including a 200% increase in overdose deaths from opioids. Opioid overdose morbidity and mortality can be prevented by early administration of naloxone hydrochloride. It has been shown that providing take-home naloxone rescue kits (NRK) to at-risk patients in the community setting reduces mortality from opioid overdose and is cost effective under highly conservative estimates. We hypothesized that providing NRKs to patients who presented to the emergency department (ED) for heroin overdose would reduce the composite outcome of opioid overdose-related repeat ED visits, hospital admission(s) and death. We chose a retrospective analytic cohort study design. We studied patients who presented to a large urban ED for heroin overdose over a 31-month period from 2013-2016, recording whether each patient received an NRK at discharge or not. We recorded the following outcomes: opioid overdose-related repeat emergency department visit(s), hospital admission(s) or presentation to the county medical examiner’s office following a fatal opioid overdose at 3 and 6 months after initial ED overdose. We compared the patients who received an NRK at discharge with those who did not to determine if there was a difference in the composite outcome using the Chi Square statistical test. We reviewed 995 ED charts with opioid overdose-related ICD-9 or ICD -10 diagnosis codes and 397 patients with a heroin overdose were identified, 69 of these patients met exclusion criteria and were not included in analysis. An additional 41 patients were not included in analysis due to minor missing data. A total of 291(29%) patients were analyzed, of which 205 (70%) were male and the median age was 34 years (IQR 27-43). At time of initial heroin overdose, 208 (71%) of the 291 patients were discharged from the ED with an NRK. There were 7 total subsequent opioid overdose deaths, all of whom received an NRK; 5 deaths (2 female and 3 male) occurred between 0-3 months following initial overdose and 2 deaths (both male) between 3-6 months following initial overdose. Those who did not receive an NRK did not have a significantly higher incidence of death at 3 or 6 months, p =0.15, and p =0.36, respectively. At 3 months, 21 (7%) reached the composite end point and at 6 months 36 (12%) reached the composite end point. No significant difference in outcome was detected among patients who received an NRK and those who did not who reached the composite outcome at 3 months (p= 0.9) or at 6 months (p=0.99). Our study did not demonstrate a significant difference in the outcomes between patients who received an NRK in the ED following a heroin overdose. Interpretation of these results may be limited due to our small sample size and number of patients who reached the composite endpoint. While this pilot study is limited due to its scale, it may provide information integral to the design and application of future investigations.