Description and Evaluation of an Academic Hospital Naloxone Distribution Pilot Program

• Published in: Journal of psychosomatic research Vol. 109; p. 94
• Main Authors: Castillo, F., Jakubowski, A., Pappas, A., Silvera, R., Isaacsohn, L., Masyukova, M., Scalise, D., Agerwala, S., Cunningham, C., Bachhuber, M.
• Format: Journal Article
• Language: English
• Published: London Elsevier Inc 01.06.2018; Elsevier Science Ltd
• Subjects: At risk populations; Benzodiazepines; Buprenorphine; Drug addiction; Health care management; Health services; Heroin; Hospital administration; Hospitalization; Imprisonment; Medical education; Mental disorders; Mental institutions; Mentoring; Methadone; Morphine; Naloxone; Narcotics; Opioids; Overdose; Pharmacy; Psychiatric hospitals; Psychiatry; Teams; Withdrawal
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2018.03.034

Aims: To implement an overdose education and naloxone distribution (OEND) program on medical and psychiatric wards of an urban academic medical center. Methods: An OEND consult service was piloted on 2 medical units and 1 inpatient psychiatric unit. Eight residents from three specialties (Psychiatry, Internal Medicine, Family Medicine) staffed the service with two faculty mentors. Take-home naloxone kits were obtained from the New York City Department of Health free of charge and incorporated into the inpatient pharmacy formulary. Primary teams placed a consult for patients at risk of opioid overdose who were then assessed by the OEND consult service. Eligibility criteria included: opioid use disorder, high dose opioid use (≥50 morphine meq daily), concurrent use of opioids with benzodiazepines or alcohol, current hospitalization for opioid overdose or withdrawal, methadone or buprenorphine use, recent incarceration, and patient request. Patient understanding was assessed through teach-back and a naloxone kit was provided. Results: From April 2016 to January 2018, the OEND consult service received 151 consults, resulting in 142 eligible patients. Of those, 35 (25%) used ≥50 morphine meq daily, 37 (26%) used opioids with benzodiazepines or alcohol, 44 (31%) used heroin, 43 (30%) used daily methadone or buprenorphine, 16 (11%) were hospitalized for opioid overdose or withdrawal, 13 (9%) had opioid use disorder and 2 (1%) requested kits. Of eligible patients, 119 (83%) had not received OEND previously, and 95 (67%) were trained and provided naloxone. Of the 47 eligible who were not trained, 29 (62%) declined, 7(15%) were discharged or left against medical advice before training, and 11 (23%) already had a naloxone kit. Conclusion: OEND implementation on inpatient wards is possible. The majority of eligible patients had never received OEND, suggesting that inpatient wards provide unique opportunities to reach at-risk populations. To expand this program, a full-time OEND trainer was hired to educate and proactively identify at-risk patients from the medical record.