Skip to main content

Advertisement

SpringerLink
Log in

Naloxone Administration in US Emergency Departments, 2000–2011

  • Original Article
  • Published:
Journal of Medical Toxicology Aims and scope Submit manuscript

Abstract

Rates of opioid overdose and opioid-related emergency department (ED) visits have increased dramatically. Naloxone is an effective antidote to potentially fatal opioid overdose, but little is known about naloxone administration in ED settings. We examined trends and correlates of naloxone administration in ED visits nationally from 2000 to 2011. Using data from the National Hospital Ambulatory Medical Care Survey, we examined ED visits involving (1) the administration of naloxone or (2) a diagnosis of opioid overdose, abuse, or dependence. We assessed patient characteristics in these visits, including concomitant administration of prescription opioid medications. We used logistic regression to identify correlates of naloxone administration. From 2000 to 2011, naloxone was administered in an estimated 1.7 million adult ED visits nationally; 19 % of these visits recorded a diagnosis of opioid overdose, abuse, or dependence. An estimated 2.9 million adult ED visits were related to opioid overdose, abuse, or dependence; 11 % of these visits involved naloxone administration. In multivariable logistic regression models, patient age, race, and insurance and non-rural facility location were independently associated with naloxone administration. An opioid medication was provided in 14 % of visits involving naloxone administration. Naloxone was administered in a minority of ED visits related to opioid overdose, abuse, or dependence. Among all ED visits involving naloxone administration, prescription opioids were also provided in one in seven visits. Further work should explore the provider decision-making in the management of opioid overdose in ED settings and examine patient outcomes following these visits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Paulozzi LJ, Jones CM, Mack KA, Rudd RA. Vital signs: overdoses of prescription opioid pain relievers - United States, 1999-2008: centers for disease control and prevention. 2011.

  2. Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015;49(3):409–13. doi:10.1016/j.amepre.2015.02.020.

    Article  PubMed  Google Scholar 

  3. Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–8.

    Article  PubMed  Google Scholar 

  4. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–6.

    Article  PubMed  Google Scholar 

  5. Jones CM. Frequency of prescription pain reliever nonmedical use: 2002-2003 and 2009-2010. Arch Intern Med. 2012;172(16):1265–7.

    Article  PubMed  Google Scholar 

  6. Hedegaard H, Chen L-H, Warner M. Rates of drug poisoning deaths involving heroin,* by selected age and racial/ethnic groups - United States, 2002 and 2011: centers for disease control and prevention; 2014.

  7. Cai R, Crane E, Poneleit K, Paulozzi L. Emergency department visits involving nonmedical use of selected prescription drugs - United States, 2004-2008: centers for disease control and prevention. 2010.

  8. Paulozzi L, Baldwin G, Franklin G, Kerlikowske RG, Jones CM, Ghiya N et al. CDC grand rounds: prescription drug overdoses - a U.S. Epidemic: centers for disease control and prevention. 2012.

  9. Coben JH, Davis SM, Furbee PM, Sikora RD, Tillotson RD, Bossarte RM. Hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers. Am J Prev Med. 2010;38(5):517–24.

    Article  PubMed  Google Scholar 

  10. Doyon S, Aks SE, Schaeffer S. Expanding access to naloxone in the United States. J Med Toxicol. 2014;10(4):431–4.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Beletsky L, Rich JD, Walley AY. Prevention of fatal opioid overdose. JAMA. 2012;308(18):1863–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Injury Prevention & Control: Prescription Drug Overdose. Centers for disease control and prevention. 2015. http://www.cdc.gov/drugoverdose/. Accessed October 7, 2015.

  13. Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Coffin PO, Sullivan SD. Cost-effectiveness of distributing naloxone to heroin users for lay overdose reversal. Ann Intern Med. 2013;158(1):1–9.

    Article  PubMed  Google Scholar 

  15. Compton WM, Volkow ND, Throckmorton DC, Lurie P. Expanded access to opioid overdose intervention: research, practice, and policy needs. Ann Intern Med. 2013;158(1):65–6.

    Article  PubMed  Google Scholar 

  16. Attorney General Holder Announces Plans for Federal Law Enforcement Personnel to Begin Carrying Naloxone. United States department of Justice, Office of Public Affairs. 2014. www.justice.gov/opa/pr/2014/July/14-ag-805.html. Accessed October 7, 2015.

  17. Petzel RA. Under secretary for Health's information letter: implementation of opioid overdose education and naloxone distribution (OEND) to reduce risk of opioid-related death. Washington, DC: Department of Veterans Affairs, Veterans Health Administration; 2014.

    Google Scholar 

  18. Etherington J, Christenson J, Innes G, Grafstein E, Pennington S, Spinelli JJ, et al. Is early discharge safe after naloxone reversal of presumed opioid overdose? CJEM. 2000;2(3):156–62.

    CAS  PubMed  Google Scholar 

  19. Lidder S, Ovaska H, Archer JR, Greene SL, Jones AL, Dargan PI, et al. Doctors’ knowledge of the appropriate use and route of administration of antidotes in the management of recreational drug toxicity. Emerg Med J. 2008;25(12):820–3.

    Article  CAS  PubMed  Google Scholar 

  20. Nissen LM, Wong KH, Jones A, Roberts DM. Availability of antidotes for the treatment of acute poisoning in Queensland public hospitals. Aust J Rural Health. 2010;18(2):78–84.

    Article  PubMed  Google Scholar 

  21. Thanacoody RH, Aldridge G, Laing W, Dargan PI, Nash S, Thompson JP, et al. National audit of antidote stocking in acute hospitals in the UK. Emerg Med J. 2013;30(5):393–6.

    Article  PubMed  Google Scholar 

  22. Kaplan JL, Marx JA, Calabro JJ, Gin-Shaw SL, Spiller JD, Spivey WL, et al. Double-blind, randomized study of nalmefene and naloxone in emergency department patients with suspected narcotic overdose. Ann Emerg Med. 1999;34(1):42–50.

    Article  CAS  PubMed  Google Scholar 

  23. Barsan WG, Seger D, Danzl DF, Ling LJ, Bartlett R, Buncher R, et al. Duration of antagonistic effects of nalmefene and naloxone in opiate-induced sedation for emergency department procedures. Am J Emerg Med. 1989;7(2):155–61.

    Article  CAS  PubMed  Google Scholar 

  24. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS). National Center for Health Statistics. www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm. Accessed October 7, 2015.

  25. Baca CT, Grant KJ. Take-home naloxone to reduce heroin death. Addiction. 2005;100(12):1823–31.

    Article  PubMed  Google Scholar 

  26. McCaig LF, Burt CW. Understanding and interpreting the national hospital ambulatory medical care survey: key questions and answers. Ann Emerg Med. 2012;60(6):716–21. e1.

    Article  PubMed  Google Scholar 

  27. Lin RJ, Reid MC, Chused AE, Evans AT. Quality assessment of acute inpatient pain management in an academic health center. Am J Hosp Palliat Care. 2014.

  28. Ramachandran SK, Haider N, Saran KA, Mathis M, Kim J, Morris M, et al. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. J Clin Anesth. 2011;23(3):207–13.

    Article  PubMed  Google Scholar 

  29. Gordon DB, Pellino TA. Incidence and characteristics of naloxone use in postoperative pain management: a critical examination of naloxone use as a potential quality measure. Pain Manag Nurs. 2005;6(1):30–6.

    Article  PubMed  Google Scholar 

  30. Rosenfeld DM, Betcher JA, Shah RA, Chang YH, Cheng MR, Cubillo EI et al. Findings of a naloxone database and its utilization to improve safety and education in a tertiary care medical center. Pain Pract. 2015.

  31. Lindstrom HA, Clemency BM, Snyder R, Consiglio JD, May PR, Moscati RM. Prehospital naloxone administration as a public health surveillance tool: a retrospective validation study. Prehosp Disaster Med. 2015;30(4):385–9.

    Article  PubMed  Google Scholar 

  32. Doe-Simkins M, Quinn E, Xuan Z, Sorensen-Alawad A, Hackman H, Ozonoff A, et al. Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study. BMC Public Health. 2014;14:297.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Drug Abuse Warning Network. 2011: national estimates of drug-related emergency department visits. Rockville: Substance Abuse and Mental Health Services Administration; 2013.

    Google Scholar 

  34. Hasegawa K, Espinola JA, Brown DF, Camargo Jr CA. Trends in US emergency department visits for opioid overdose, 1993-2010. Pain Med. 2014;15(10):1765–70.

    Article  PubMed  Google Scholar 

  35. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Interagency Guidelines on Opioid Dosing for Chronic Non-cancer Pain. Washington State Agency Medical Directors’ Group. 2010. http://www.agencymeddirectors.wa.gov/files/opioidgdline.pdf. Accessed October 7, 2015.

  37. Wheeler E, Davidson PJ, Jones TS, Irwin KS. Community-based opioid overdose prevention programs providing naloxone—United States, 2010: centers for disease control and prevention. 2012.

  38. Binswanger IA, Koester S, Mueller SR, Gardner EM, Goddard K, Glanz JM. Overdose education and naloxone for patients prescribed opioids in primary care: a qualitative study of primary care staff. J Gen Intern Med. 2015.

  39. Green SM. Congruence of disposition after emergency department intubation in the national hospital ambulatory medical care survey. Ann Emerg Med. 2013;61(4):423–6. e8.

    Article  PubMed  Google Scholar 

  40. Carlson JN, Wang HE. The challenge of analyzing and interpreting NHAMCS. Ann Emerg Med. 2013;62(1):99–100.

    Article  PubMed  Google Scholar 

  41. Bogenschutz MP, Donovan DM, Mandler RN, Perl HI, Forcehimes AA, Crandall C, et al. Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med. 2014;174(11):1736–45.

    Article  PubMed  PubMed Central  Google Scholar 

  42. D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Gugelmann HM, Perrone J. Can prescription drug monitoring programs help limit opioid abuse? JAMA. 2011;306(20):2258–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA

    Joseph W. Frank, Susan L. Calcaterra & Ingrid A. Binswanger

  2. VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA

    Joseph W. Frank & Cari Levy

  3. Division of Health Care Policy and Research, University of Colorado, Mailstop F-480, 13199 E. Montview Blvd., Suite 400, Aurora, CO, 80045, USA

    Cari Levy

  4. Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA

    Susan L. Calcaterra

  5. Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA

    Jason A. Hoppe

  6. Rocky Mountain Poison and Drug Center, 777 Bannock Street, Denver, CO, 80204, USA

    Jason A. Hoppe

  7. Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO, 80231, USA

    Ingrid A. Binswanger

Authors
  1. Joseph W. Frank
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cari Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan L. Calcaterra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jason A. Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ingrid A. Binswanger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph W. Frank.

Ethics declarations

Conflict of Interest

All authors declare that they have no conflict of interest.

Funding

Dr. Frank was supported by the University of Colorado School of Medicine and the VA Eastern Colorado Health Care System. Dr. Levy was supported by the Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care. Dr. Calcaterra was supported by the University of Colorado School of Medicine and by Denver Health Medical Center. Dr. Binswanger was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R34DA035952. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding organizations had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frank, J.W., Levy, C., Calcaterra, S.L. et al. Naloxone Administration in US Emergency Departments, 2000–2011. J. Med. Toxicol. 12, 148–156 (2016). https://doi.org/10.1007/s13181-015-0525-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13181-015-0525-5

Keywords

Search

Navigation