Feasibility of an ED-Based Take-Home Naloxone Brief Intervention

A take-home naloxone (THN) brief intervention (THN-BI) program delivered at emergency departments (EDs) was found to be feasible and reach a wide range of individuals at risk for opioid overdose. The study findings were published in Emergency Medicine Australia.

The open-label pilot feasibility study was conducted at 3 metropolitan teaching and tertiary referral inner city hospitals in Australia. Staff were surveyed about their THN opinions and received a 30-minute THN-BI training for delivering the intervention. Patients presenting at the ED with opioid overdose or those who were at high risk for future overdose were eligible to receive the THN-BI. Clinician opinions and patient characteristics were assessed.

A total of 122 hospital staff who were nurses (53.3%), junior medical officers (22.1%), staff specialists (16.4%), or other staff members (8.2%) participated in the program.

Most staff members agreed (43%) or strongly agreed (9.9%) they could advise patients about overdose prevention. The potential barriers for delivering the THN-BI were time constraints and fear of making patients feel uncomfortable. Staff specialists were more likely than other staff members to recommend naloxone (P =.044), and nurses were more likely than staff specialists to be uncomfortable in discussing overdose (P =.008).

THN-BI was delivered to 57 patients. These patients were 71.4% men, had a median age of 44 (IQR, 33-50) years, 66.0% had overdosed with heroin, 58.7% received intramuscular naloxone injection, and median hospital stay was 24 (IQR, 12-48) hours.

The characteristics of patients who overdosed with heroin (n=31) or pharmaceutical opioids (n=16) differed for intentionality of overdose (P =.010), opioid use disorder status (P =.001), presence of mental illness (P =0.000), chronic respiratory disease (P =.005), prescribed sedatives (P =.001), prescribed opioids (P =.049), prescribed polypharmacy (P =.001), and overdose management (P =.040).

This study was limited by the COVID-19 pandemic, in which the investigators were unable to assess staff for changes in their perception of the program after implementation.

“ED-based THN interventions are feasible in Australia and generally acceptable to staff involved in their delivery,” the study authors wrote. “Important implementation factors requiring consideration include provision of adequate staff training and support; tailoring of the intervention to include people using illicit and/or prescription opioids and development of localized ED protocols. Further translational research is needed to better understand factors that will enable implementation, along with sustainable funding models to eliminate cost barriers for consumers.”

Reference

Black E, Monds LA, Chan B, et al. Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with ‘take-home naloxone’ in emergency departments. Emerg Med Australas. Published online January 12, 2022. doi:10.1111/1742-6723.13925