O'Brien-Lambert Clare, Althoff Keri, Barvincak Jennifer, Cirbus Halle, Singer-Pomerantz Safia, Cowan Ethan
Icahn School of Medicine at Mount Sinai.
Johns Hopkins Bloomberg School of Public Health.
J Emerg Med. 2024 Dec;67(6):e590-e598. doi: 10.1016/j.jemermed.2024.05.016. Epub 2024 Jun 4.
Increasing the equitable distribution of take home naloxone (THN) may result in reduced deaths from opioid overdose (OD).
The primary study objective is to describe the demographic and clinical characteristics of emergency department (ED) patients who decline THN. The findings of this descriptive study may generate new hypotheses for successful THN distribution.
Retrospective chart review using prospectively collected program evaluation data from a single urban EDs Health Education THN database and electronic health record. Characteristics of participants who refused versus accepted THN were compared using Chi-square testing for categorical variables and t-tests for continuous variables. A multivariate model was built to assess associations of statistical and clinically relevant characteristics with THN refusal.
A total of 711 ED patients were offered THN of which 334 (46%) declined. In unadjusted analysis, with the independent variable being refusal of the THN offer, being currently on medication for opioid use disorder (MOUD) was associated with a greater odds of refusal (OR 1.9, 95%CI 1.3-2.6) while any drug related overdose (OR 0.6, 95%CI 0.4-0.8) or being given a prescription for buprenorphine in the ED (OR 0.2, 95%CI 0.1-0.9) were both associated with a lower odds of refusal.
Demographic characteristics did not differ between those who accept versus refuse THN. Patients already receiving MOUD were more likely to refuse THN while those starting MOUD in the ED were less likely to refuse THN. Further studies are needed to determine the root causes of patients' declination of THN and develop targeted interventions to address these causes.
增加带回家的纳洛酮（THN）的公平分配可能会降低阿片类药物过量（OD）导致的死亡人数。
本研究的主要目的是描述拒绝THN的急诊科（ED）患者的人口统计学和临床特征。这项描述性研究的结果可能会为成功分发THN产生新的假设。
使用前瞻性收集的来自单个城市急诊科健康教育THN数据库和电子健康记录的项目评估数据进行回顾性图表审查。使用卡方检验对分类变量和t检验对连续变量比较拒绝与接受THN的参与者的特征。建立多变量模型以评估统计和临床相关特征与THN拒绝之间的关联。
共有711名急诊科患者被提供了THN，其中334名（46%）拒绝了。在未调整的分析中，自变量为拒绝THN的提供，目前正在接受阿片类药物使用障碍（MOUD）治疗与更高的拒绝几率相关（OR 1.9，95%CI 1.3-2.6），而任何与药物相关的过量（OR 0.6，95%CI 0.4-0.8）或在急诊科接受丁丙诺啡处方（OR 0.2，95%CI 0.1-0.9）均与较低的拒绝几率相关。
接受与拒绝THN的人群在人口统计学特征上没有差异。已经接受MOUD治疗的患者更有可能拒绝THN，而在急诊科开始接受MOUD治疗的患者不太可能拒绝THN。需要进一步研究以确定患者拒绝THN的根本原因，并制定针对性的干预措施来解决这些原因。
