Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 122 Blockley Hall, 421 Guardian Drive, Philadelphia, PA, 19104, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Harm Reduct J. 2022 Aug 26;19(1):97. doi: 10.1186/s12954-022-00677-7.
Emergency departments (EDs) are important venues for the distribution of naloxone to patients at high risk of opioid overdose, but less is known about patient perceptions on naloxone or best practices for patient education and communication. Our aim was to conduct an in-depth exploration of knowledge and attitudes toward ED naloxone distribution among patients who received a naloxone prescription.
We conducted semi-structured telephone interviews with 25 adult participants seen and discharged from three urban, academic EDs in Philadelphia, PA, with a naloxone prescription between November 2020 and February 2021. Interviews focused on awareness of naloxone as well as attitudes and experiences receiving naloxone in the ED. We used thematic content analysis to identify key themes reflecting patient attitudes and experiences.
Of the 25 participants, 72% had previously witnessed an overdose and 48% had personally experienced a non-fatal overdose. Nineteen participants (76%) self-disclosed a history of substance use or overdose, and one reported receiving an opioid prescription during their ED visit and no history of substance use. In interviews, we identified wide variability in participant levels of knowledge about overdose risk, the role of naloxone in reducing risk, and naloxone access. A subset of participants was highly engaged with community harm reduction resources and well versed in naloxone access and use. A second subset was familiar with naloxone, but largely obtained it through healthcare settings such as the ED, while a final group was largely unfamiliar with naloxone. While most participants expressed positive attitudes about receiving naloxone from the ED, the quality of discussions with ED providers was variable, with some participants not even aware they were receiving a naloxone prescription until discharge.
Naloxone prescribing in the ED was acceptable and valued by most participants, but there are missed opportunities for communication and education. These findings underscore the critical role that EDs play in mitigating risks for patients who are not engaged with other healthcare or community health providers and can inform future work about the effective implementation of harm reduction strategies in ED settings.
急诊科（ED）是向有阿片类药物过量风险的患者分发纳洛酮的重要场所，但对于患者对纳洛酮的认知或最佳患者教育和沟通实践知之甚少。我们的目的是深入探讨在宾夕法尼亚州费城的三个城市学术急诊部接受纳洛酮处方的患者对 ED 纳洛酮分配的知识和态度。
我们对 2020 年 11 月至 2021 年 2 月期间在三个城市学术急诊部就诊并出院的 25 名成年患者进行了半结构化电话访谈，这些患者均收到了纳洛酮处方。访谈重点是对纳洛酮的认识，以及在 ED 接受纳洛酮的态度和经验。我们使用主题内容分析来确定反映患者态度和经验的关键主题。
25 名参与者中，72%的人曾目睹过过量用药，48%的人曾亲身经历过非致命性过量用药。19 名参与者（76%）自行透露有药物使用或过量用药史，1 名参与者报告在 ED 就诊期间收到阿片类药物处方且无药物使用史。在访谈中，我们发现参与者对过量风险、纳洛酮在降低风险中的作用和纳洛酮的获取途径的了解程度存在很大差异。一组参与者高度参与社区减少伤害资源，对纳洛酮的获取和使用非常熟悉。另一组参与者虽然熟悉纳洛酮，但主要通过医疗保健环境（如 ED）获得，而最后一组参与者对纳洛酮则知之甚少。虽然大多数参与者对从 ED 获得纳洛酮表示积极态度，但与 ED 提供者的讨论质量参差不齐，一些参与者直到出院才意识到他们正在接受纳洛酮处方。
ED 开具纳洛酮处方被大多数参与者接受和重视，但沟通和教育的机会仍然存在。这些发现强调了 ED 在减轻未参与其他医疗保健或社区卫生提供者的患者风险方面的关键作用，并为未来在 ED 环境中实施减少伤害策略的有效实施提供了信息。
