Opioids
Loren Bonner
Even as opioid overdose deaths have reached record highs during the COVID-19 pandemic, patients being treated for overdose in U.S. emergency departments (EDs) didn’t receive lifesaving medications before discharge, suggests a new study published in the Annals of Emergency Medicine.
Chua and colleagues found that only 1 in 13 patients received a naloxone prescription within 30 days of their ED visit for opioid overdose. Additionally, only 1 in 12 patients were given a buprenorphine prescription within 30 days.
“These low rates of prescribing occurred against a backdrop of rapidly escalating numbers of opioid overdose deaths,” said Kao-Ping Chua, MD, PhD, lead author of the study and assistant professor of pediatrics at Michigan Medicine.
In contrast, almost half of patients who visited an ED for anaphylaxis received a prescription for epinephrine, another lifesaving rescue medication.
“The epinephrine comparison was one of the most striking findings,” said Chua. “Clinicians don’t think twice about prescribing EpiPens after anaphylaxis. Why would they not automatically prescribe naloxone to patients after an opioid overdose? The answer probably has to do with stigma and an unfounded fear that prescribing naloxone could increase risky drug use.”
The numbers
Chua and his research team conducted a retrospective cohort analysis using data from more than 5,800 hospitals and 70,000 pharmacies in the United States.
Their analysis of data from nearly 149,000 ED visits from August 4, 2019, to April 3, 2021, for opioid overdose before and during the pandemic revealed that only 7.4% of patients received a prescription for naloxone within 30 days. The prescription rate for buprenorphine was just 8.5%.
“Our findings are consistent with several older studies that found low rates of naloxone and buprenorphine dispensing after emergency department visits for opioid overdose among privately insured patients,” said Chua. “The naloxone prescribing rate in our study was slightly higher than in these previous studies but was still far too low.”
Chua said their study improves upon prior analyses because it uses a timely national database that includes patients of all insurance types and represents about one-third of all U.S. ED visits. However, one limitation is that the uninsured were not represented well in the database used, according to Chua.
Access issues
“Our study shows how much work needs to be done to ensure that every patient leaving the emergency department after an opioid overdose has a naloxone prescription or a naloxone take-home kit,” said Chua.
As low as the naloxone prescribing rate was, an even lower percentage of patients had filled a naloxone prescription at a pharmacy, according to the findings. Chua said this could be due to a variety of factors, including lack of access to pharmacies that stock naloxone and refusal of pharmacists to dispense naloxone. ■
Making the case for short-acting opioids to treat opioid withdrawal
Could there be a place for short-acting opioids in the hospital to improve care for patients going through opioid withdrawal? Authors of a new commentary published in Annals of Internal Medicine think so.
“There are several ways that buprenorphine and methadone [aren’t] meeting the needs of all hospitalized patients experiencing opioid withdrawal symptoms,” said Robert Kleinman, MD, one of the commentary authors who is from the Centre for Addiction and Mental Health, and Department of Psychiatry at the University of Toronto. “There are other medications that may reduce suffering and improve treatment for patients with OUD.”
He said that short-acting opioids have several pharmacodynamic properties that may allow them to improve the treatment for hospitalized patients experiencing opioid withdrawal.
More standard treatments, such as methadone and buprenorphine, are not sufficient for treating all patients’ withdrawal symptoms and have pharmacologic limitations that may limit their utility within the inpatient setting, according to Kleinman.
“While there are case reports of using short-acting opioids to treat opioid withdrawal and the experience of hospitals internationally, we are not aware of studies assessing whether the use of short-acting opioids can improve these outcomes,” said Kleinman. “This is an important area of research, and ultimately perspective control trials are necessary to test our hypothesis that short-acting opioids will improve outcomes.”