Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 University Blvd., Birmingham, AL, 35294, USA.
Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
Harm Reduct J. 2022 Jul 26;19(1):84. doi: 10.1186/s12954-022-00667-9.
Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. The objective of this study was to characterize the naloxone prescribing rate in patients with opioid use disorder (OUD) at the University of Alabama at Birmingham Hospital in 2019 and 2020.
A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020. Naloxone prescribing, defined as either a written prescription or a provided take-home kit, was assessed for all patients with OUD.
In 2019, 11,959 visits were made by 2962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020; 609 naloxone prescriptions were provided in 2019 (5.1%) and 619 in 2020 (5.3%). In both years, most OUD-related visits and naloxone prescriptions were from and to male, white, individuals. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (33.2% vs 44.3%, p < 0.05), and more OUD patients were admitted to inpatient settings (26.0% vs 31.2%, p < 0.05) and received more naloxone prescriptions in the inpatient setting (46.3% vs 62.0%, p < 0.05) in 2020. The proportion of frequent users (i.e., visits ≥ 4 times/year) increased in 2020 for the emergency department (21.5% vs 26.4%, p < 0.001) and inpatient setting (24.9% vs 28.6%, p = 0.03).
Our findings indicate the need for improving naloxone awareness in providers and prescribing for patients with OUD, particularly in emergency department and outpatient settings. Our results also demonstrated a disparity in naloxone prescribing; a disproportionate number of opioid-related emergency department visits and overdose deaths were noted in Black people and frequent users.
根据疾病控制与预防中心的数据，估计 2019 年 9 月至 2020 年 9 月期间，美国有 69710 例阿片类药物过量死亡。然而，在此期间，纳洛酮的处方数量是否增加或波动情况尚不清楚。本研究的目的是描述 2019 年和 2020 年阿拉巴马大学伯明翰分校医院阿片类药物使用障碍（OUD）患者的纳洛酮处方率。
对 2019 年 1 月至 2020 年 12 月期间的 OUD 患者进行了一项横断面、回顾性病历审查。对所有 OUD 患者评估了纳洛酮的处方情况，定义为书面处方或提供的带离试剂盒。
2019 年，2962 名独特的 OUD 患者就诊 11959 次，而 2020 年就诊 2641 名独特的 OUD 患者就诊 11661 次；2019 年提供了 609 份纳洛酮处方（5.1%），2020 年提供了 619 份（5.3%）。在这两年中，大多数与 OUD 相关的就诊和纳洛酮处方都是男性、白人患者。与 2019 年相比，2020 年有更多的无保险患者获得纳洛酮处方（33.2%比 44.3%，p<0.05），更多的 OUD 患者被收治到住院环境（26.0%比 31.2%，p<0.05），并在住院环境中获得更多的纳洛酮处方（46.3%比 62.0%，p<0.05）。2020 年，急诊部门（21.5%比 26.4%，p<0.001）和住院部门（24.9%比 28.6%，p=0.03）的高频使用者（即就诊次数≥4 次/年）比例增加。
我们的研究结果表明，需要提高提供者对纳洛酮的认识并为 OUD 患者开具处方，特别是在急诊和门诊环境中。我们的结果还表明纳洛酮的处方存在差异；黑人患者和高频使用者的阿片类药物相关急诊就诊和过量死亡人数不成比例。
