Fatalities caused by overdose from opioids are increasing in Vermont. Evidence shows that Naloxone safely and effectively reverses the effects of opioids in overdose. This project aims to determine why physicians in VT Emergency Departments are not consistently distributing Naloxone to all patients with an overdose, and to increase awareness and implementation of this practice.https://scholarworks.uvm.edu/fmclerk/1149/thumbnail.jp

Harris, Olivia M.

UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects College of Medicine2016Increasing Naloxone Distribution in VTEmergency DepartmentsOlivia M. HarrisUVM College of MedicineFollow this and additional works at: http://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in FamilyMedicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationHarris, Olivia M., "Increasing Naloxone Distribution in VT Emergency Departments" (2016). Family Medicine Clerkship StudentProjects. Book 123.http://scholarworks.uvm.edu/fmclerk/123Increasing Naloxone Distribution in VT Emergency DepartmentsStowe Family PracticeOlivia HarrisFamily Medicine (12.14.2014 – 1.22.2015)Mentor: Dr. Katherine Marvin MDThe Problem:• Drug overdose was the leading cause of  injury death in 2013 (CDC)• Deaths involving opioids have risen dramatically over the last 5 years in Vermont• Deaths from heroin doubled from 2012 to 2013 1• 50+ Vermonters die from opioid overdose each year 1• Preliminary data shows that between January-September of  2015, there were already 55 deaths involving an opioid in VT 1The Problem:• It is critical that physicians be aware of, and address this problem:• “Approximately two-thirds of  individuals with addiction will see a primary care or urgent care physician every six months, and many others are regularly examined by other medical specialists.” 2• Despite the availability of  Naloxone (Narcan), an opioid receptor antagonist which effectively and safely reverses the detrimental effects of  opioids, Emergency Department physicians in Vermont are not distributing Naloxone kits to all overdose patients• Physician apprehension to prescribing Naloxone involves:• lack of  awareness 3, • negative attitudes towards drug users 3, • belief  that distributing Naloxone will increase drug use 3, and • fear of  liabilityA price to pay• “Drug misuse and abuse caused about 2.5 million emergency department (ED) visits in 2011.” 4• “Among those ED visits, 420,040 visits were related to opioid analgesics.” 4• “In the United States, prescription opioid abuse costs were about $55.7 billion in 2007. Of  this amount, 46% was attributable to workplace costs (e.g., lost productivity), 45% to healthcare costs (e.g., abuse treatment), and 9% to criminal justice costs.” 4Community PerspectiveBrief  interviews were conducted with two ED physicians, and with participants at a VT Medically Assisted Treatment (MAT) learning collaborative:• An ED physician from Copley Hospital in Stowe, VT endorses a commonly held belief  that prescribing Naloxone to patients with overdose in the ED enables them to continue using, and to use more opioids• Conversely, a physician from Treatment Associates states that,• “Anyone who is not participating in the Narcan movement is a victim of  bias against those with the disease of  addiction. Addiction should be treated the same as any other disease, like hypertension or diabetes.”Community Perspective• A physician working in UVMMC Emergency Department agrees that Naloxone kits need to be distributed to any patient who comes to the ED with an overdose. When asked about why this is not occurring, Dr. Clauss responded that some physicians may not be aware of  this option, some of  these patients leave prematurely before the kit can be provided, and that many patients are given information about where they can get free Naloxone kits in the community• However, an RN involved in the MAT at Stowe Family Practice, feels that Naloxone kits need to be provided at the time of  the ED visit rather than redirecting patients to community resources due to the unreliability of  this patient population, lack of  transportation, and lack of  accessible community resources in many areas of  VermontMethodology & Intervention• Methodology:• A literature review was performed to explore:• attitudes of  physicians regarding Naloxone prescription, and to assess the validity of  commonly held beliefs among this population• The effectiveness of  distributing Naloxone kits to patients with opioid overdose in regard to prevention of  future overdose, safety, and cost-effectiveness• Investigation of  whether physicians at the UVMMC Emergency Department are prescribing Naloxone kits• Sought help in performing a PRISM search to assess how many patients were treated for an overdose in the last 6 months• Contacted a pharmacist at UVMMC to collect data on the number of  kits prescribed • Intervention:• After compiling the data found in the literature review, an informational pamphlet was developed to be distributed among emergency department physicians with the hope of  increasing awareness and ultimately increasing the distribution of  Naloxone kits in this settingResults & Response Data• Evidence in the literature shows that:• Overdose deaths are significantly reduced in areas where Naloxone distribution programs have been implemented 5• Providing Naloxone “does not encourage opiate users to increase their drug consumption, nor does it increase the likelihood that they will harm themselves or those around them.” 3• Participation in Naloxone distribution programs reduces the use of  opioids and increases users' desire to seek addiction treatment. 6• Naloxone has no psychoactive effects or potential for abuse, and studies have indicated “extremely low rates of  adverse events in numerous pilot studies of  distribution” 6• In addition, legal changes have been made to protect physicians who prescribe Naloxone, described in Act 75 in Vermont (http://www.vtmd.org/act-75-prescription-drug-abuse-prevention-and-monitoring-implementation-timeline)Results and Response Data • A basic PRISM search using “heroin overdose” and “opiate overdose” as discharge diagnoses showed 43 patients between 6/1/2015 – 11/30/2015• UVMMC Pharmacy distributed 17 Naloxone kits during this same time periodEvaluation of  Effectiveness & Limitations• Evaluating effectiveness:• Another PRISM search with an accompanying evaluation of  the number of  Naloxone kits distributed at UVMMC should be performed 6 months following the distribution of  the information packets to determine whether the number of  kits more closely matches the number of  patients treated for an opioid overdose• Limitations of  this project include:• Short period of  time within which to complete the project• Difficulty capturing the real number of  patients treated for overdose at UVMMC due to variation in discharge diagnoses used Future Projects• Future projects may aim to:• Gain a better understanding of  physicians’ attitudes in Vermont Emergency Departments regarding the prescription of  Naloxone kits through personal interviews, survey’s/questionnaires, etc.• Develop a separate information pamphlet for patients regarding the safety and efficacy of  Naloxone kits in preventing overdose fatalities from opiates• Broaden the distribution of  information packets to include primary care physicians as well as other emergency departments in VermontReferences:• 1) Data Brief: Vermont Drug-Related Fatalities 2010-2014. Vermont Department of  Health. http://healthvermont.gov/research/documents/databrief_drug_related_fatalities.pdf• 2) Beletsky, L., Ruthazer, R, Macalino, G, Rich, J, Tan, L, Burris, S. Physicians’ Knowledge of  and Willingess to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities. J Urban Health. Jan. 2007. 84(1): 126-136.• 3) Bazazi, A, Zaller, N, Fu, J, Rich, J. Preventing Opiate Overdose Deaths: Examining Objections to Take-Home Naloxone. J Health Care Poor Underserved. Nov 2010; 21 (4): 1109-1113.• 4) Injury Prevention & Control: Prescription Drug Overdose. Centers for Disease Control and Prevention. http://www.cdc.gov/drugoverdose/data/overdose.html• 5) Walley, A, Xuan, Z, Hackman, H, Simkin, M, Sorensen-Alawad, A. Opioid Overdose Rates and Implementation of  Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis. BMJ Jan 2013. 346:f174.• 6) Kim, D, Irwin, K, Khoshnood, K. Expanded Access to Naloxone: Options for Critical Response to the Epidemic of  Opioid Overdose Mortality. Am J Public Health. March 2009; 99(3): 402-407

Increasing Naloxone Distribution in VT Emergency Departments

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Increasing Naloxone Distribution in VT Emergency Departments

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