(Boston) - Emergency departments (ED) provide a promising venue to address opioid deaths with education on both overdose prevention and appropriate actions in a witnessed overdose. In addition, ED's have the potential to equip patients with nasal naloxone rescue kits as part of this effort.
These findings are from a study published in the Western Journal of Emergency Medicine, and is the first study to demonstrate the feasibility of ED-based opioid overdose prevention education and naloxone distribution to trained laypersons, patients and their social network.
In the United States, deaths from prescription opioid overdose increased from 4,041 in 1999 to 16,651 in 2010. In 2011, an estimated 420,040 ED visits were related to overdose of prescription opioids and 258,482 heroin overdoses.
Since 1993, Boston Medical Center's (BMC) Project ASSERT has offered alcohol and drug use screening, brief intervention and referral to treatment to patients treated for intoxication in the ED. In 2009, Project ASSERT, with support from Boston Public Health Commission and Massachusetts Department of Public Health, also began offering overdose prevention education and naloxone rescue kits to emergency department patients at risk for opioid overdose.
In order to evaluate the feasibility of this program and describe the overdose risk knowledge, opioid use, and overdose response actions among patients receiving overdose prevention education, researchers from Boston University School of Medicine (BUSM) and BMC conducted a telephone survey of Project ASSERT patients between January 2011 and February 2012. Of the 415 patients who received overdose education during this time, 51 patients were surveyed. Of these 51 patients, 73 percent had received a naloxone rescue kit either in the emergency department or elsewhere, such as a detox facility, and approximately one third of the reported opioid use in the last 30 days.
In addition, more than half had reported witnessing an overdose and calling 911 for help. Among those with naloxone rescue kits, about one-third administered naloxone during the rescue.
"This study confirms that the emergency department provides a promising opportunity for opioid overdose harm reduction measures through overdose education and naloxone rescue kit distribution," explained lead author Kristin Dwyer, MD, emergency physician at BMC. "Our program reached a high-risk population that commonly witnessed overdoses, called for help and used naloxone to rescue people, when available," she added.
Although the study was retrospective with a low response rate, the researchers believe this study provides useful information for planning larger studies and programs to further evaluate implementation, benefits and harms of overdose prevention efforts in EDs.
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The research was made possible by the support of the Department of Emergency Medicine and an Evans Junior Faculty Merit Award, Boston University School of Medicine, Department of Medicine.
Editor's note
In September 2013, as a result of this pilot project, BMC adopted a policy to make take home naloxone and education accessible to at risk ED patients prior to discharge, not only through Project ASSERT, but also through the inpatient and outpatient pharmacies. In 2014 Project ASSERT distributed 191 Naloxone rescue kits to ED patients and their social contacts; more than three time the number of kits distributed during the 2011 study period.
About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 482-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $118 million in sponsored research funding in fiscal year 2014. It is the 11th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving more than 315,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.
Journal
Western Journal of Emergency Medicine