Is Naloxone use in Southeast Alabama Rising? Evaluation of Naloxone Administration in an Emergency Department Setting

Abstract

BackgroundFatalities caused by drug‐overdose have increased greatly in recent years across the US and is now the leading cause of injury‐related death in the United States. Drug related deaths with cointoxicants are being seen far too often and the increase in prevalence of opioid overdoses with possible concomitant medication use is a public health concern that needs to be addressed. Naloxone (Narcan ®) is an opioid antagonist approved in November 2015 by the FDA to help combat the effects of opioid overdose. Awareness of naloxone’s availability over the counter and education on opioid related overdoses for communities in the United States has been shown to improve opioid overdose deaths. In this study, we document naloxone administration in the Southeast Health Emergency Department to help identify high risk sub‐populations in this region that present with signs of potential opioid overdose and the connection between overdoses for opioids or a cointoxicant.Study DesignA retrospective study was conducted evaluating the administration of naloxone in individuals arriving in the emergency department at Southeast Health from August 01, 2011 to August 31, 2018. Patient cases were collected based on time, route, and dose of naloxone given, and data was then selected based on ICD 10 codes and documented positive reaction to naloxone. Patients who were not between ages 18–89 or were incarcerated or pregnant prior to their hospital were excluded from this study. Further data was collected on patients’ socioeconomic status, medical history, and the course of their encounter.ResultsOf the 721 charts reviewed, 261 were deemed true overdoses and 51 were possible overdoses. While there were more overdoses in individuals with a history of chronic pain or mental illness, this was not statistically significant. The data showed most patients who overdosed were taking both opioids and benzodiazepines.ConclusionsIt is apparent that disabled/retired females over 65 with Medicare or Medicaid were the most likely to be a true opioid overdose.Due to the patient’s mental status upon arrival, not all charts had complete histories or medication records. There were no clear documentation standards, so this varied from by provider and year, making it difficult to determine if there was a true overdose. Data was also dependent on patient honesty, relying on them to admit a history of abuse or what substances they had taken. The number of cases of overdose is likely under reported. Southeast Health is not the only hospital in the area. Emergency responders or home naloxone may have been administered decreasing the number of emergency consults. When considering patients insurance status, only the primary insurance listed was recorded. A patient could have also had a Medicaid plan indicating low income, but this was not noted.Age DistributionFigure 1Naloxone and Past Medical HistoryFigure 2