title: Factors Associated With Participation in an Emergency Department-Based Take-Home Naloxone Program for At-Risk Opioid Users.
abstract: OBJECTIVE
  Although the World Health Organization recommends take-home naloxone to address the increasing global burden of opioid-related deaths, few emergency departments (EDs) offer a take-home naloxone program. We seek to determine the take-home naloxone acceptance rate among ED patients at high risk of opioid overdose and to examine factors associated with acceptance.
  
  
  METHODS
  At a single urban ED, consecutive eligible patients at risk of opioid overdose were invited to complete a survey about opioid use, overdose experience, and take-home naloxone awareness, and then offered take-home naloxone. The primary outcome was acceptance of take-home naloxone, including the kit and standardized patient training. Univariate and multivariable logistic analyses were used to evaluate factors associated with acceptance.
  
  
  RESULTS
  Of 241 eligible patients approached, 201 (83.4%) completed the questionnaire. Three-quarters of respondents used injection drugs, 37% were women, and 26% identified as "Indigenous." Of 201 respondents, 137 (68.2%; 95% confidence interval [CI] 61.7% to 74.7%) accepted take-home naloxone. Multivariable analysis revealed that factors associated with take-home naloxone acceptance included witnessing overdose in others (odds ratio [OR] 4.77; 95% CI 2.25 to 10.09), concern about own overdose death (OR 3.71; 95% CI 1.34 to 10.23), female sex (OR 2.50; 95% CI 1.21 to 5.17), and injection drug use (OR 2.22; 95% CI 1.06 to 4.67).
  
  
  CONCLUSIONS
  A two-thirds ED take-home naloxone acceptance rate in patients using opioids should encourage all EDs to dispense take-home naloxone. ED-based take-home naloxone programs have the potential to improve access to take-home naloxone and awareness in individuals most vulnerable to overdoses.
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: andrew.kestler@ubc.ca.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kestler
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Buxton
authors.affiliation: Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gray
authors.initials: G
authors.lastname: Meckling
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Giesler
authors.affiliation: School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fuller
authors.affiliation: Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada.
authors.forename: Hong
authors.initials: H
authors.lastname: Quian
authors.affiliation: London School of Tropical Medicine & Hygiene.
authors.forename: Dalya
authors.initials: D
authors.lastname: Marks
authors.affiliation: Department of Emergency Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Scheuermeyer
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000188:drug therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone