Chang Grace, Davids Michelle, Kershaw Alan
a VA Boston Healthcare System , Brockton , Massachusetts , USA.
b Harvard Medical School , Boston , Massachusetts , USA.
J Addict Dis. 2017 Oct-Dec;36(4):217-221. doi: 10.1080/10550887.2017.1333331. Epub 2017 May 26.
Patients with opioid use disorder are at a high risk of overdose. To minimize that risk, a program offering intranasal naloxone rescue kits was piloted at a Veterans Administration Hospital. The purpose of this study was to characterize veterans who accepted these potentially lifesaving kits. Retrospective medical chart review of 158 veterans with opioid use disorder receiving treatment on either the inpatient psychiatry detoxification units or outpatient methadone maintenance setting who were offered overdose education and naloxone rescue kits. One hundred and ten of 158 veterans (70%) accepted overdose education and naloxone rescue. Overall, they had a mean age of 39.1 years and averaged 12.7 years of opioid use. In the prior month, they averaged 14.3 days of heroin use; they used alone 48.5% of the time. They estimated an average of 2.8 accidental overdoses over their lifetimes. There were few significant differences between those who accepted and those who declined with regard to demographic and clinical variables. However, significantly higher percentages of outpatients accepted overdose education and naloxone rescue compared to inpatients (89% versus 63%, p = 0.003, Chi-square); the odds of acceptance were increased four-fold when offered to outpatients. Outpatients were nearly a decade older, with more years of opioid use (19.0 versus 11.0), but with less utilization of inpatient services in the prior year (all p < 0.05). The main finding was that 70% of veterans accepted overdose education and naloxone rescue, but significantly higher proportions of outpatients were more receptive than inpatients (89% versus 63%, p = 0.003). Efforts to increase overdose education and naloxone rescue acceptance in all settings are encouraged.
患有阿片类药物使用障碍的患者面临着很高的过量用药风险。为了将这种风险降至最低，一家退伍军人管理局医院试点开展了一项提供鼻内纳洛酮急救包的项目。本研究的目的是描述接受这些可能挽救生命的急救包的退伍军人的特征。对158名患有阿片类药物使用障碍且在住院精神科戒毒单元或门诊美沙酮维持治疗环境中接受治疗的退伍军人进行回顾性病历审查，这些退伍军人接受了过量用药教育和纳洛酮急救包。158名退伍军人中有110名（70%）接受了过量用药教育和纳洛酮急救。总体而言，他们的平均年龄为39.1岁，平均有12.7年的阿片类药物使用史。在前一个月，他们平均有14.3天使用海洛因；他们48.5%的时间是独自使用。他们估计一生中平均有2.8次意外过量用药。在人口统计学和临床变量方面，接受者和拒绝者之间几乎没有显著差异。然而，与住院患者相比，门诊患者接受过量用药教育和纳洛酮急救的比例显著更高（89%对63%，p = 0.003，卡方检验）；向门诊患者提供时，接受的几率增加了四倍。门诊患者的年龄将近大十岁，有更多年的阿片类药物使用史（19.0年对11.0年），但前一年住院服务的使用率较低（所有p < 0.05）。主要发现是70%的退伍军人接受了过量用药教育和纳洛酮急救，但门诊患者接受的比例明显高于住院患者（89%对63%，p = 0.003）。鼓励在所有环境中努力提高过量用药教育和纳洛酮急救的接受率
