348 Trends in the Reports of Naloxone as Reported to a Regional US Poison Center

Abstract

The U.S. Department of Health and Human Services recommends expanding naloxone access as a priority area as the opioid crisis worsens. The objective of this study is to evaluate the trends and describe the demographic and clinical characteristics of calls from the emergency department (ED) to a regional poison center (PC), where naloxone was being recommended or utilized as therapy as well as determine the role of the PCs in making the initial decision on naloxone administration. ToxicallTM, a comprehensive and robust case management software system that is used by 75% of U.S. PCs, was queried at a single regional poison center for ED based closed, human records where naloxone as therapy was recommended or performed from 01/01/11 through 12/31/16. The relevant demographic and clinical characteristics were descriptively assessed. Proportion of yearly “not recommended but performed” (NRP) naloxone therapy reports among overall naloxone reports were evaluated at the regional level. Annual trends in overall and NRP naloxone therapy reports were analyzed using simple linear regression methods and trends in the rates of NRP naloxone calls per 1000 human exposure calls and 1000 intentional human exposure calls were also assessed. Overall, there were 254 calls made to the regional PC for cases in or en route to the ED, where naloxone was recommended or performed as therapy. The number of calls increased from 43 in 2011 to 53 in the year 2016, despite an overall drop in PC calls during the same time period. The proportion of NRP naloxone reports at the regional level PC trended upward from 2011 to 2016 (93% vs 96.2%). Of calls where naloxone was recommended or performed as therapy, 78.7% were intentional exposures, with suicide suspected in 35.8% and abuse reported in 37.8% of cases. Overall, 20-29 years (27.6%) and 30-39 years (22.4%) were the most frequent age groups. Specifically, among drug abuse cases, the 20-29 year-old group accounted for nearly half the cases. Among the cases where naloxone therapy was reported, the proportion of males (59.1%) was higher as compared to females (40.1%). Approximately 31 patients (12.2%) exhibited major effects with 3 reported deaths. The prominent clinical effects included coma (19.2%) and drowsiness (63%). Other frequent therapies reported in conjunction with naloxone were intubation (9 cases), ventilator (11 cases), and NAC IV (7 cases). The rate of NRP naloxone reports per 1,000 human exposure ED calls received by the regional poison center was higher in 2016 as compared to 2011 (15.9 vs 13.3). Annual trends in the NRP calls per 1,000 intentional human exposure calls from the ED indicated an increase from 29.1 calls in 2011 to 34.5 calls in 2016. Regression analysis demonstrated that the number of NRP naloxone calls to the regional PC increased at a rate of 2 more calls per year (95% CI: 0.43-4.13; p=0.01). Review of the regional data demonstrated a significant increase in naloxone as therapy from 2011-2016 associated with calls to PCs for the cases en route or in the EDs. In the majority of the cases, naloxone is being performed before calling the PC.