title: Naloxone Administration in US Emergency Departments, 2000-2011.
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.
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA. joseph.frank@ucdenver.edu.|VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA. joseph.frank@ucdenver.edu.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Frank
authors.affiliation: VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO, 80207, USA.|Division of Health Care Policy and Research, University of Colorado, Mailstop F-480, 13199 E. Montview Blvd., Suite 400, Aurora, CO, 80045, USA.
authors.forename: Cari
authors.initials: C
authors.lastname: Levy
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA.|Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calcaterra
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Avenue, Aurora, CO, 80045, USA.|Rocky Mountain Poison and Drug Center, 777 Bannock Street, Denver, CO, 80204, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Hoppe
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Mailstop B180, 12631 East 17th Avenue, Aurora, CO, 80045, USA.|Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO, 80231, USA.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004636:Emergency Service, Hospital; D005260:Female; D019538:Health Care Surveys; D019456:Health Transition; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010818:Practice Patterns, Physicians' / Q000639:trends; D000067490:Prescription Drug Overuse / Q000009:adverse effects / Q000639:trends; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control*; D014481:United States; D000078329:Workforce; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone
keywords: Drug overdose; Emergency department; Naloxone; Opioid analgesics