254 Rates of Naloxone Prescriptions Following Implementation of a Take-Home Naloxone Program from the Emergency Department

Abstract

Opioid-related overdose death has more than quadrupled over the past three decades, mirroring trends in emergency department (ED) visits for opioid-related misuse and abuse. Recent studies have shown decreased mortality due to opioid overdose in communities with take-home naloxone (THN) programs. The methods of naloxone distribution vary across programs, with some programs providing naloxone directly to the patient and others providing naloxone prescriptions. The objective of this study was to determine the effectiveness of a THN program that utilizes naloxone prescriptions, with medication dispensing at a pharmacy, at two tertiary care EDs for patients presenting with a chief complaint related to opioid overdose. A multidisciplinary THN program was implemented at Harborview Medical Center and the University of Washington Medical Center in Seattle, WA. Eligible patients for THN (4mg/0.1ml nasal spray or 1mg/ml syringe) included those who were being discharged from the ED and met any inclusion criteria for risk of opioid overdose. Prior to discharge, patients received teaching, a naloxone prescription, and discharge instructions specific to heroin or pharmaceutical opioid overdose risk. Patients were then encouraged to fill the prescription at the hospital pharmacy, at no cost if needed, during available business hours (0900-1930) or through an after-hours pharmacy protocol where the naloxone was delivered to the ED. Pharmacists or ED staff, depending on pharmacy hours, dispensed the medication and provided teaching on naloxone. For this analysis, we reviewed data from October 1, 2015 to September 30, 2016 for patients who had a chief complaint consistent with opioid overdose, identified patients who received THN prescriptions, and then verified those who filled THN at one of our affiliated hospital pharmacies. A total of 744 patient encounters were identified to be at risk of opioid overdose between the two emergency departments over the study period. Take-home naloxone prescriptions were written for 83 encounters (11.1%) and 12 prescriptions (1.6%) were filled. Two patients were given and filled multiple prescriptions. Opioid overdose is a frequent presentation to the emergency department, but rates of naloxone prescription and filling through this THN program were marginal. True prescription fill rates may be underrepresented due to limitations in naloxone prescription tracking and a lack of outside pharmacy dispensing data. Additionally, it is unclear if patients were offered THN, but declined or were noted to already have THN. To further understand the impact of a THN program, EDs should consider prescription filling patterns, pharmacy access, and EHR data limitations. Identifying barriers to naloxone prescription and filling, unique to the emergency department, may improve naloxone distribution.