Less than 10% of opioid overdose patients are

As opioid overdose deaths skyrocket during the COVID-19 pandemic, a Michigan Medicine study found that the vast majority of patients treated for opioid overdoses in emergency departments in the United States do not receive two potentially life-saving drugs before leaving the hospital or in the weeks following.

Analysis of data from nearly 149,000 opioid overdose emergency room visits before and during the pandemic reveals that only 7.4% of patients were prescribed naloxone, an overdose rescue drug often available under Narcan’s name, within 30 days. The prescription rate for buprenorphine, a drug to treat opioid dependence, was only 8.5%.

The results, published in the Annals of Emergency Medicine, come just as the Centers for Disease Control and Prevention announced it Drug overdoses in the United States topped 100,000 for the first time in a 12-month period that ended in April 2021, an increase of 28.5% over the same period a year earlier. The new study analyzes prescriptions written after emergency room visits for overdose between August 2019 and April 2021.

The surprisingly low number of prescriptions for naloxone and buprenorphine highlights many missed opportunities to equip patients with rescue medications to use in the event of future overdose of themselves or others, and to begin drug treatment. appropriate in the emergency department and follow-up care, says Kao-Ping Chua, MD, Ph.D., lead author of the study and assistant professor of pediatrics at Michigan Medicine.

“In light of record levels of opioid overdose deaths, prescription low levels of naloxone and buprenorphine are simply unacceptable,” Chua said. “Clinicians are missing out on critical life-saving opportunities both in the emergency department and during follow-up after overdose visits. “

Naloxone can be given by the nose or by injection, like the epinephrine used for people with severe allergies. It is designed to restore normal breathing during an overdose and is increasingly available free of charge in pharmacies and other places. Buprenorphine is also an opioid, but it is designed to block the action of other opioid drugs, including prescription drugs, heroin, and fentanyl. The drug helps people reduce or eliminate their dependence on opioid use, without causing euphoria per se.

The power of these drugs to help people avoid future overdoses and get help with addictions is what prompted researchers to study prescriptions filled by people being treated for opioid overdoses. They also looked at patients treated for severe allergic reactions – anaphylaxis – in the same emergency departments during the same time period. Almost half of these patients received prescriptions for an emergency epinephrine device, such as an Epipen, within 30 days of their visit.

“The same standard that we use to treat patients after anaphylaxis and prepare them with a potentially life-saving prescription should also be applied to patients after an opioid overdose,” said Keith Kocher, MD, MPH, lead author of the article and associate professor of emergency medicine at Michigan Medicine. “There are several points of intervention along the way to reduce the potential damage after an overdose. The emergency department has a role to play, as do ambulatory care providers. It may not always be the same solutions in every environment or community, but the bottom line is that we need to do better. “

The risk that patients who survive an opioid overdose will die from another overdose is high. In a 2019 study, researchers found 1.1% of patients treated for an opioid overdose died within a month and 5.5% died within the year.

Kocher and Chua both recommend that, at a minimum, emergency physicians prescribe naloxone to patients who overdose, and health systems should encourage this prescription. Chua notes that there is still a stigma surrounding prescribing the overdose reversal agent.

“Some clinicians believe that prescribing naloxone encourages patients to engage in risky behaviors, again increasing their risk of overdose,” he said. “But there isn’t a lot of evidence that this is happening.”

When it comes to buprenorphine, the emergency departments have not traditionally been seen as the place to begin drug treatment, but we do know that emergency room visits are used as ‘learning moments’ for the patient. trying to introduce patients to many other types of treatment and lifestyle changes, says Kocher. .

“We hope these statistics will reduce the noise because we are concerned that people will have this unwanted experience in the weeks and months following an overdose,” he said.

Doctors looking to prescribe buprenorphine to patients face additional hurdles. They must apply for a waiver from the United States Drug Enforcement Agency and can still only prescribe the drug to 30 patients per year without having to meet additional requirements. But this last spring, other obstacles have been removed, which should allow more doctors to start treating their patients with a drug that could change their lives, Chua says.

“Congress must completely eliminate the waiver requirement for buprenorphine,” he said. “We shouldn’t need a dispensation to prescribe buprenorphine when we don’t need a dispensation to prescribe opioids. “

Kocher and his colleagues from Working together to improve Michigan’s emergency department have worked for several years to increase the number of emergency physicians and emergency teams in Michigan who can provide naloxone free of charge to at-risk patients, including overdose survivors, and put patients on buprenorphine. In partnership with the Michigan Opioid Prescribing Engagement Network, they created guides for emergencies to help them start and maintain programs to encourage the prescribing of the two drugs, and have held in-person and online training sessions to help physicians prepare to prescribe buprenorphine, including meeting federal requirements.

They have also provided thousands of naloxone kits free of charge to the emergency room and created lists of pharmacies that have “standing orders” for naloxone in many counties in Michigan, which allow patients to access the drug without a prescription. a specific doctor.

Cited article: “Prescription of naloxone and buprenorphine following visits to the emergency services of the United States for suspected opioid overdose: August 2019 to April 2021” Annals of Emergency Medicine. DOI: 10.1016 / j.annemergmed.2021.10.005

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