Dr. Kathryn Dong completed her emergency medicine training and a Masters of Science in Population Health at the University of Alberta. In partnership with the community, and with funding from the Royal Alexandra Hospital Foundation, she launched the Inner City Health and Wellness Program, including the Addiction Recovery and Community Health (ARCH) Team, in 2014. After practicing emergency medicine for 11 years at the Royal Alex, Kathryn went on to complete additional certification in addiction medicine and now her clinical practice is as a physician on the ARCH Team.
Node Funded Project (February 2018)
Title: Access To Take Home Naloxone (THN) in the Royal Alexandra Hospital’s Emergency Department (ED) for Patients At Risk Of An Opioid Overdose
Principal Investigator: Kathryn Dong, University of Alberta
Elaine Hyshka, Kay Rittenbach, Daniel O’Brien, Daniel Dabbs (University of Alberta); Nick Etches, Jennifer Brouwer (AHS)
Opioid-related morbidity and mortality continues to increase in Alberta. Dispensing THN kits through the ED is particularly critical because previous ED visits for opioid overdose strongly predict future overdose mortality. The purpose of this study is to investigate the reach of the RAH ED-based THN program, with the goal of generating knowledge useful for improving THN delivery at the RAH and other acute care settings, and informing the sparse scientific literature on ED-based THN programs. Our specific research objectives are to: (1) quantify the proportion of individuals who visited the ED for an opioid overdose who received a THN kit, (2) identify the sociodemographic and clinical characteristics of those patients who are not accessing THN kits, either because they were not offered one by the ED staff, or because they refused a THN kit after it was offered, and (3) develop recommendations for optimizing ED-based THN programs.
We retrospectively reviewed medical records from all ED visits between April 2016 and May 2017 with a primary diagnosis of opioid overdose at a large, urban tertiary hospital located in Alberta, Canada. A wide array of patient data was collected, including demographics, opioid intoxicants, prescription history, overdose severity, and whether a naloxone kit was offered and accepted. Multivariable analyses were used to identify patient characteristics and situational variables associated with being offered THN.
Among the 342 ED visits for opioid overdose, THN was offered in 49% (n = 168) of cases. Patients were more likely to be offered THN if they had been found unconscious (Adjusted Odds Ratio 3.70; 95% Confidence Interval [1.63, 8.37]), or if they had smoked or injected an illegal opioid (AOR 6.05 [2.15,17.0] and AOR 3.78 [1.32,10.9], respectively). In contrast, patients were less likely to be offered THN if they had a current prescription for opioids (AOR 0.41 [0.19, 0.88]), if they were admitted to the hospital (AOR 0.46 [0.22,0.97], or if they unexpectedly left the ED without treatment or before completing treatment (AOR 0.16 [0.22, 0.97).
In this real-world evaluation of an ED-based THN program, we observed that only half of patients with opioid overdose were offered THN. ED staff readily identify patients who use illegal opioids or experience a severe overdose as potentially benefitting from THN, but may miss others at high risk for future overdose. We recommend that hospital EDs provide additional guidance to staff to ensure that all eligible patients at risk of overdose have access to THN.
- O’Brien, D. C., Dabbs, D., Dong, K., Veugelers, P. J., Hyshka, E. (2019). Patient characteristics associated with being offered take home naloxone in a busy, urban emergency department: A retrospective chart review. BMC Health Services Research. 19(1), 1-12.