Study objective

Nonfatal emergency department (ED) visits for opioid overdose are important opportunities to prescribe naloxone and buprenorphine, both of which can prevent future overdose-related mortality. We assessed the rate of this prescribing using national data from August 2019 to April 2021, a period during which US opioid overdose deaths reached record levels.

Methods

We conducted a retrospective cohort analysis using Symphony Health’s Integrated Dataverse, which includes data from 5,800 hospitals and 70,000 pharmacies. Of ED visits for opioid overdose between August 4, 2019, and April 3, 2021, we calculated the proportion with at least 1 naloxone prescription within 30 days and repeated this analysis for buprenorphine. To contextualize the naloxone prescribing rate, we calculated the proportion of ED visits for anaphylaxis with at least 1 prescription for epinephrine—another life-saving rescue medication—within 30 days.

Results

Analyses included 148,966 ED visits for opioid overdose. Mean weekly visits increased 23.6% during the period between April 26, 2020 and October 3, 2020 compared with the period between August 4, 2019 to April 25, 2020. Visits declined to prepandemic levels between October 4, 2020 and March 13, 2021, after which visits began to rise. Naloxone and buprenorphine were prescribed within 30 days at 7.4% and 8.5% of the 148,966 visits, respectively. The naloxone prescribing rate (7.4%) was substantially lower than the epinephrine prescribing rate (48.9%) after ED visits for anaphylaxis.

Conclusion

Between August 4, 2019, and April 3, 2021, naloxone and buprenorphine were only prescribed after 1 in 13 and 1 in 12 ED visits for opioid overdose, respectively. Findings suggest that clinicians are missing critical opportunities to prevent opioid overdose-related mortality.

中文翻译：

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2019 年 8 月至 2021 年 4 月美国急诊科因疑似阿片类药物过量就诊后开出纳洛酮和丁丙诺啡处方

 学习目的

因阿片类药物过量服用非致命性急诊科 (ED) 就诊是开纳洛酮和丁丙诺啡的重要机会，这两种药物都可以预防未来与药物过量相关的死亡。我们使用 2019 年 8 月至 2021 年 4 月的国家数据评估了这种处方的比例，在此期间美国阿片类药物过量死亡达到创纪录水平。

 方法

我们使用 Symphony Health 的 Integrated Dataverse 进行了回顾性队列分析，其中包括来自 5,800 家医院和 70,000 家药房的数据。在2019年8月4日至2021年4月3日期间因阿片类药物过量就诊的急诊室中，我们计算了30天内至少开出1张纳洛酮处方的比例，并对丁丙诺啡重复了这一分析。为了了解纳洛酮处方率，我们计算了 30 天内因过敏反应而到急诊室就诊的比例，其中至少开过 1 次肾上腺素（另一种救命药物）处方。

 结果

分析包括 148,966 次因阿片类药物过量而就诊的急诊室。与2019年8月4日至2020年4月25日期间相比，2020年4月26日至2020年10月3日期间平均每周访问量增加了23.6%。2020年10月4日至2021年3月13日期间访问量下降至大流行前的水平，此后访问量开始上升。在 148,966 次就诊中，30 天内服用纳洛酮和丁丙诺啡的比例分别为 7.4% 和 8.5%。因过敏反应到急诊室就诊后，纳洛酮处方率 (7.4%) 显着低于肾上腺素处方率 (48.9%)。

 结论

2019年8月4日至2021年4月3日期间，纳洛酮和丁丙诺啡仅在因阿片类药物过量而到急诊室就诊的比例分别为十分之一和十二分之一。研究结果表明，临床医生错过了预防阿片类药物过量相关死亡的关键机会。