Abstract
BackgroundOpioid overdoses are at an epidemic in the United States causing the deaths of thousands each year. Project DAWN (Deaths Avoided with Naloxone) is an opioid overdose education and naloxone distribution program in Ohio that distributes naloxone rescue kits at clinics and in the emergency departments of a single hospital system.MethodsWe performed a retrospective analytic cohort study comparing heroin overdose survivors who presented to the emergency department and were subsequently discharged. We compared those who received a naloxone rescue kit at discharge with those who did not. Our composite outcome was repeat opioid overdose related emergency department visit(s), hospitalization and death at 0–3 months and at 3–6 months following emergency department overdose. Heroin overdose encounters were identified by ICD- 9 or 10 codes and data was abstracted from the electronic medical record for emergency department patients who presented for heroin overdose and were discharged over a 31- month period between 2013 and 2016. Patients were excluded for previous naloxone access, incarceration, suicidal ideation, admission to the hospital or death from acute overdose on initial emergency department presentation. Data was analyzed with the Chi- square statistical test.ResultsWe identified 291emergency department heroin overdose encounters by ICD-9 or 10 codes and were analyzed. A total of 71% of heroin overdose survivors received a naloxone rescue kit at emergency department discharge. Between the patients who did not receive a naloxone rescue kit at discharge, no overdose deaths occurred and 10.8% reached the composite outcome. Of the patients who received a naloxone rescue kit, 14.4% reached the composite endpoint and 7 opioid overdose deaths occurred in this cohort. No difference in mortality at 3 or 6 months was detected, p = 0.15 and 0.36 respectively. No difference in the composite outcome was detected at 3 or 6 months either, p = 0.9 and 0.99 respectively.ConclusionsOf our emergency department patients receiving a naloxone rescue kit we did not find a benefit in the reduction of repeat emergency department visits hospitalizations, or deaths following a non-fatal heroin overdose.
Highlights
Opioid overdoses are at an epidemic in the United States causing the deaths of thousands each year
Patients were excluded from further review if there was documentation of the following: previous Naloxone rescue kit (NRK) access, prescription for naloxone, incarceration while in the emergency department (ED), reported suicidal ideation, admission to the hospital or death from acute overdose on initial ED presentation
We evaluated the effect of take-home NRKs in adult ED patients presenting for heroin overdose who were subsequently discharged over a 31- month period between September 1, 2013 and April 1, 2016
Summary
Opioid overdoses are at an epidemic in the United States causing the deaths of thousands each year. Many opioid dependent users transitioned to heroin as a more cost-effective alternative to prescription opioids, which were becoming more difficult to obtain beginning in 2010 [4, 7, 8] This transition was first described in a study of heroin users entering drug treatment in the last decade in which 75% reported that they were first introduced to heroin from prescription drugs [7]. This substitution of prescription opioids for heroin led to a tripling of overdose deaths over a four-year period [2]. Overdose fatalities in Ohio attributed to fentanyl increased steadily as well: 4% in 2013, 19.9% in 2014, 37.9% in 2015 and 58.2% in 2016
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
