a Division of General Internal Medicine, Department of Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.
b Department of Family and Social Medicine , Montefiore Medical Center/Albert Einstein College of Medicine , Bronx , New York , USA.
Subst Abus. 2019;40(1):61-65. doi: 10.1080/08897077.2018.1518836. Epub 2018 Nov 26.
Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on 2 general medicine floors at Montefiore Medical Center, a large urban academic medical center in Bronx, New York. The planning committee consisted of 10 resident physicians and 2 faculty mentors. A consult service model was piloted, whereby the primary inpatient care team paged the consult team (consisting of rotating members from the planning committee) for any newly admitted patient who had used any opioid in the year prior to admission. Consult team members assessed patients for eligibility and provided OEND to eligible patients through a short video training. Upon completion, patients received a take-home naloxone kit. To evaluate the program, a retrospective chart review over the first year (April 2016 to March 2017) of the pilot was conducted. Overall, consults on 80 patients were received. Of these, 74 were eligible and the consult team successfully trained 50 (68%). Current opioid analgesic use of ≥50 morphine milligram equivalents daily was the most common eligibility criterion met (38%). Twenty-four percent of patients were admitted for an opioid-related adverse event, the most common being opioid overdose (9%), then opioid withdrawal (8%), skin complication related to injecting (5%), and opioid intoxication (2%). Twenty-five percent had experienced an overdose, 35% had witnessed an overdose in their lifetime, and 83% had never received OEND previously. Integrating OEND into general inpatient medical care is possible and can reach high-risk patients who have not received OEND previously. Future research should identify the optimal way of implementing this service.
对有目击或经历阿片类药物过量风险的人群进行过量用药教育和纳洛酮分发（OEND）传统上是通过减少伤害机构提供的。将 OEND 扩展到住院一般医疗环境中可能会接触到那些没有接受减少伤害服务且没有接受过培训的高危人群。一项针对住院患者的 OEND 计划在纽约布朗克斯市大型城市学术医疗中心蒙蒂菲奥里医疗中心的 2 个普通内科病房进行了开发、试点和评估。 规划委员会由 10 名住院医师和 2 名教师导师组成。试点了一种咨询服务模式，即初级住院医疗团队向咨询团队（由规划委员会的轮换成员组成）呼叫，以了解任何在入院前一年使用过任何阿片类药物的新入院患者。咨询团队成员评估患者是否符合条件，并通过简短的视频培训向符合条件的患者提供 OEND。完成培训后，患者会收到一个带纳洛酮回家的工具包。为了评估该计划，对试点的第一年（2016 年 4 月至 2017 年 3 月）进行了回顾性图表审查。 总体而言，共收到了 80 名患者的咨询。其中，74 名符合条件，咨询团队成功培训了 50 名（68%）。最常见的符合条件标准是当前阿片类药物镇痛剂的使用量≥50 毫克吗啡当量/天（38%）。24%的患者因阿片类药物相关不良事件入院，最常见的是阿片类药物过量（9%），其次是阿片类药物戒断（8%）、与注射相关的皮肤并发症（5%）和阿片类药物中毒（2%）。25%的患者曾经历过药物过量，35%的患者在其一生中曾目睹过药物过量，83%的患者以前从未接受过 OEND。 将 OEND 纳入一般住院医疗护理是可行的，可以接触到以前没有接受过 OEND 的高危人群。未来的研究应确定实施这项服务的最佳方式。
