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Naloxone Prescriptions Increase at US Hospitals

A new study by Rutgers University has revealed that rates of naloxone prescriptions have increased in emergency departments (ED) throughout the United States over the past decade. The study provides insight into the positive impact of federal policies and regulations aimed at addressing the opioid epidemic.

Naloxone is a medication that can reverse the effects of opioids and prevent unintentional deaths caused by overdose. Federal opioid prescribing guidelines in 2016 made it easier for doctors to prescribe naloxone to patients at high risk for opioid overdose. The study found that the rise in naloxone prescriptions coincided with an increase in opioid prescriptions during ED stays and at discharge.

The study, published in The American Journal of Emergency Medicine, analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationwide representative sample conducted annually by the National Center for Health Statistics. The researchers found that of the more than 1.1 billion emergency visits recorded, an estimated 250,365 visits ended with naloxone prescribed at discharge, and the rate of naloxone prescriptions written increased over the years of the study.

Increase in Co-Prescribing of Naloxone and Opioids

The study also found an increase in the rate of naloxone prescriptions when opioids were administered therapeutically during the ED visit. Although the reasons for this are unclear, it may indicate an increase in provider cognizance about the risks of opioids. At the beginning of the study period in 2012, no visits met this criterion, but at the end of the study in 2019, 22,070 visits met the criterion.

The researchers also found that 44,625 visits involved co-prescriptions of opioids and naloxone at discharge. No co-prescriptions were written in 2012, but this number climbed to 28,621 in 2019.

Addressing the Larger Rate of Opioid-Related Complications

While the study is encouraging, researchers noted that the prescribing rates are still insufficient to account for the larger rate of patients that come to the ED with an overdose or opioid-related complication. The lead author of the study, Christine Ramdin, stated that this is a trend that needs continuous improvement.

NHAMCS doesn't monitor reasons for opioid utilization or prescribing, but it does record patient intake data. The researchers found that 62 percent of patients who were prescribed naloxone at ED discharge had a substance-use disorder indicated in the record. Ramdin explained that if someone with opioid use disorder is coming in with an opioid-related complaint, they may receive an opioid for withdrawal or pain in the ED.

Future Research Needed

The study data was collected before the COVID-19 pandemic, and additional research is needed to determine how the pandemic affected these trends. Ramdin stated that while it's likely that prescriptions continued to climb, the opposite could also be true. The beginning of the pandemic was chaotic in EDs across the country, and that impacted patient care. It's conceivable that because of the patient load and the types of patients that providers were seeing in the ED, people with opioid-related concerns were not being prescribed naloxone at discharge. Future research would need to confirm this.

Journal Information: Christine Ramdin et al, Trends in naloxone prescribed at emergency department discharge: A national analysis (2012–2019), The American Journal of Emergency Medicine (2023). DOI: 10.1016/j.ajem.2023.01.006
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