Peer navigation and take-home naloxone for opioid overdose emergency department patients: Preliminary patient outcomes

Abstract

BackgroundU.S. opioid overdose deaths have increased five-fold since 1999. In 2014, two Rhode Island emergency departments (EDs) began providing take-home naloxone and peer recovery coach consultation to patients identified at risk of opioid overdose. Similar programs have been initiated throughout the country, but patient outcomes of ED naloxone distribution and recovery coach consultation have yet to be evaluated. MethodsThis is an observational, retrospective cohort study of ED patients discharged after a non-fatal opioid overdose in the six months after implementation of an ED naloxone distribution and recovery coach consultation program, September 2014 to February 2015. By provider and patient discretion, patients received either: usual care, take-home naloxone, or a recovery coach with take-home naloxone. Primary outcomes one year from index ED visit were initiation of medication for opioid use disorder (OUD), repeat ED visit for opioid overdose, and all-cause mortality. Results151 adults met study inclusion criteria. Sixty (39.7%) received usual care, 26 (17.2%) received take-home naloxone alone, and 72 (47.7%) received take-home naloxone and a peer recovery coach. Less than a third (28.5% 48/151) initiated medication for OUD. Median time to new initiation of medication for OUD was shorter among those who got a recovery coach (81.5 days vs 139 days usual care). Thirty (19.9%) were treated in the ED for a repeat opioid overdose. Seven (4.6%) died within one year of initial ED visit. A smaller proportion of deaths occurred among those receiving services. ConclusionPreliminary patient outcomes demonstrate a high frequency of death and repeat overdose one-year following an ED visit for opioid overdose. A minority initiate medication for OUD. Among those who got a recovery coach and naloxone, median.