Factors Associated With Participation in an Emergency Department–Based Take-Home Naloxone Program for At-Risk Opioid Users

• Published in: Annals of emergency medicine Vol. 69; no. 3; pp. 340 - 346
• Main Authors: Kestler, Andrew, MD, MBA, Buxton, Jane, MBBS, MHSc, Meckling, Gray, BSc, Giesler, Amanda, BSc, Lee, Michelle, BSc, MPH, Fuller, Kirsten, BSc, BScN, Quian, Hong, MSc, Marks, Dalya, PhD, Scheuermeyer, Frank, MD, MHSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Adult; Drug Overdose - drug therapy; Emergency; Emergency Service, Hospital; Female; Humans; Male; Naloxone - therapeutic use; Narcotic Antagonists - therapeutic use; Opioid-Related Disorders - prevention & control; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patient Education as Topic; Self Care - methods
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2016.07.027

Study objective Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance. Methods At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance. Results Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as “Indigenous.” Of 201 respondents, 137 (68.2%; 95% confidence interval [CI] 61.7% to 74.7%) accepted take-home naloxone. Multivariable analysis revealed that factors associated with take-home naloxone acceptance included witnessing overdose in others (odds ratio [OR] 4.77; 95% CI 2.25 to 10.09), concern about own overdose death (OR 3.71; 95% CI 1.34 to 10.23), female sex (OR 2.50; 95% CI 1.21 to 5.17), and injection drug use (OR 2.22; 95% CI 1.06 to 4.67). Conclusion A two-thirds ED take-home naloxone acceptance rate in patients using opioids should encourage all EDs to dispense take-home naloxone. ED-based take-home naloxone programs have the potential to improve access to take-home naloxone and awareness in individuals most vulnerable to overdoses.