The Emergency Department as an Opportunity for Naloxone Distribution

A Systematic Review

Alexander H. Gunn, MBS, EMT-B; Zachary P.W. Smothers, MBS, EMT-B; Nicole Schramm-Sapyta, PhD; Caroline E. Freiermuth, MD; Mark MacEachern, MLIS; Andrew J. Muzyk, PharmD, MHPE


Western J Emerg Med. 2018;19(6):1036-1042. 

In This Article


This review adheres to the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines.[18] We did not conduct a meta-analysis due to the heterogeneity of study interventions, assessments, and analysis of collected data. Extracting and grading the evidence was not possible due to the variation in outcome measures and design across included studies.

Literature Search

One author (MM) performed comprehensive searches in Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Epub Ahead of Print,, Cochrane Central Register of Controlled Trials, and CINAHL via the EBSCOhost research platform. The searches were initially run in June 2017 and rerun for the final time in April 2018. Each search consisted of a combination of ED and naloxone terminology, with appropriate, controlled vocabulary and title and abstract keyword variations. The searches yielded 2,286 citations after duplicates were removed in Endnote X6 (Clarivate Analytics). We excluded conference abstracts and conference papers from the Embase search. The searches were otherwise free of restrictions. The Ovid MEDLINE search is included in Table 1 and all complete, reproducible searches are available in a data repository at doi:10.7302/Z2WD3XSM.

Eligibility Screening

Two authors (AG and ZS) independently reviewed the titles and abstracts of all retrieved and included articles that described naloxone distribution from the ED. A third author (AM) resolved any disagreements to remove selection and scoring bias. All included papers were reviewed for any additional articles not identified in the literature database search.

The inclusion criteria required that articles do the following: (1) Be or include original research with outcomes; (2) describe a naloxone distribution from the ED; and (3) create an intervention targeted to individuals with OUD, SUD, or current opioid use. We excluded conference proceedings, thesis papers, white papers, policy recommendations, and abstracts. Although the literature search was not limited to English-only articles, all records identified through database searches were published in English. Of the records screened, the most common reasons for exclusion were not describing naloxone distribution initiatives, not describing distribution from the ED specifically, and inappropriate publication types such as dissertations or poster abstracts. Five articles met all of the inclusion criteria as shown in the PRISMA flow diagram in Figure.


Literature search and article selection.