70 Improving Access to Naloxone and Opioid Resources through the Emergency Department

Abstract

Study Objectives: Opioid abuse continues to be a significant cause of morbidity and mortality in the United States. In 2018 437 overdose deaths in Utah involved opioids. Naloxone distribution and education programs have shown to be effective in areas of high incidence. Patients were surveyed in the Emergency Department (ED) at the University of Utah to determine the feasibility of a naloxone distribution and education program. The ED could prove to be a valuable place to distribute and educate patients about naloxone. Methods: We prospectively enrolled a convenience sample of 107 patients at an urban academic medical center at the University of Utah. Data collected included baseline demographic information, outcomes of ED substance abuse testing, and inpatient evaluation, as well as a 30-day follow-up by telephone and chart review. We used eight survey questions along with a validated opioid risk score to help determine the feasibility and interest of an ED-based naloxone distribution program. Results: Over the 6-month study period, trained research associates surveyed 107 ED patients. Surprisingly 31.8% of patients interviewed had had a family member or close friend die of a drug overdose, and 23.4% of patients had a family member or close friend who currently uses opioids. Patients who had a high opioid risk score were more interested in receiving a free naloxone kit while in the ED when compared to the low- moderate risk group (73.9% vs. 41% p=0.076). Patients with a high opioid risk score were at significantly greater risk of having had a family member or close friend die of an overdose when compared to the low- moderate risk group (79.1% vs. 29.2% p=0.019). Of the patients given opioid and naloxone resources, 96.3% (n=103) did not report picking up a kit or were lost to follow up within 30 days. Conclusion: A large majority of patients surveyed had little knowledge of naloxone or how to use it. The ED could prove to be a valuable place to provide access and training given the environment. Despite many patients having considerable interest, very few followed up with the community resources offered to them in the ED. This further shows the importance of early intervention while the patients are in the ED. Consideration should also be given to kit distribution to family members, given the large number of patients that had a family member or close friend die of an overdose. Future projects should look at the opioid education that is provided in the ED.