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

Disclosures

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

Limitations

Only five articles met the inclusion criteria. This small sample size highlights the need for future research but also provides little evidence to support claims. The inclusion criteria only allowed for peer-reviewed, published literature to be reviewed. The authors recognize that ED-based, take-home naloxone programs may exist around the country but have not been reported on. Further, literature that described naloxone distribution from settings other than the ED was excluded, which limited the possibility of expanding findings to outside the ED. Finally, we could not conduct a meta-analysis due to the low number of included studies and heterogeneity of outcomes, which limits the conclusions that can be drawn from this review.

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Table 1. Literature search strategies regarding naloxone access for the three Ovid MEDLINE databases.
Search #	Search statement
1	exp naloxone/or (antioplaz or curamed or maloxone or mapin or nalone* or naloxon* or narcan or narcanti or narcon or ratiopharm or zynox).tw. or (opioid* or opiate*).ti.
2	exp emergency medical services/or exp emergency treatment/or emergenc.ti. or (emergenc adj2 (depart* or room* or service* or unit* or ward or wards)).tw.
3	and/1-2

Table 2. Implementation considerations for take-home naloxone programs in the emergency department.
Identification of personnel	Included studies used health counselors, medical student volunteers, PAs, pharmacists, physicians, and nurses.^19–23
Education and training	Lack of time available for workforce training was identified as a key barrier to successful implementation.²²
EHR integration	Only 14% of EHR notifications resulted in a prescription for take-home naloxone. Authors identified that more targeted alerts could be more effective.²¹
Patient identification and workflow	The identification of patients in the included studies was done through provider referral, listed chief complaint, listed diagnosis, and screening questionnaires.^19–23 One study recommended starting with a specific high-risk population in the ED to implement the practice and scale to other at-risk patient populations.²²
Source of funding for take-home naloxone kits	Take-home naloxone kits were funded in a variety of methods, including grant funding, billing private insurance, billing Medicaid or Medicare, and relying on a cross-sector partnerships with local and state health departments.^19–23
Pharmacy considerations	In two studies, even when naloxone was prescribed, very few were filled. To this end, a common factor identified as an enabling factor was ED patients being able to leave the ED with the take-home naloxone kits at any time of day.^20,22 Further, the type of naloxone distributed across the studies varied. The most common was a mucosal atomizer kit with a vial of naloxone.^19–23

EHR, electronic health records; ED, emergency department.

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A Systematic Review

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A Systematic Review

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