Sex, gender, and the opioid epidemic: Crucial implications for acute care

Emergency-department initiated buprenorphine: Impact on quality of life

Introduction

Emergency department (ED)-initiated medications for opioid use disorder (MOUD) have emerged as an acute care strategy against the opioid epidemic. When initiated in the outpatient setting, MOUD has been demonstrated to have a positive impact on patients' quality of life (QoL). It is unclear how engagement in ED-initiated MOUD, a novel initiation setting and unique patient cohort, might impact QoL. We sought to describe QoL variables reported by patients engaged in ED-initiated MOUD.

Methods

A retrospective observational study of an ED-initiated MOUD program was performed, inclusive of enrollments from July 2019 through February 2022. Participants were interviewed at intake, 3-months, and 6-months, during which QoL indices were measured via Government Performance and Results Act (GPRA) variables. Descriptive statistics and Pearson's Chi-Square analyses were utilized to assess the data.

Results

Of 315 participants, majority were white (78.4 %), male (64.4 %), between the ages of 25-44 (74.6 %), and heavily burdened by lack of insurance, homelessness, and unemployment. One hundred forty participants (44.4 % eligible) completed 3-month follow-up and 90 (28.5 %) completed 6-month follow-up. There were no significant demographic differences amongst respondents at 3- and 6-months as compared to intake. Objective QoL variables significantly improved at 3- and 6-months as compared to intake (p < 0.01). Subjective QoL variables also demonstrated significant improvement at follow-up (p < 0.05).

Conclusion

ED patients with OUD, eligible for MOUD, may face a number of social and interpersonal variables which heavily impact QoL. ED-initiated MOUD may positively impact subsequent QoL when measured over time.

Disparities in naloxone prescriptions in a University Hospital during the COVID-19 pandemic

BACKGROUND

Per the CDC, it is estimated that 69,710 opioid overdose deaths occurred in the United States from September 2019 to September 2020. However, it is unclear whether naloxone prescribing also increased or otherwise fluctuated in this time. The objective of this study was to characterize the naloxone prescribing rate in patients with opioid use disorder (OUD) at the University of Alabama at Birmingham Hospital in 2019 and 2020.

METHODS

A cross-sectional, retrospective medical record review was performed on patients with OUD from January 2019 through December 2020. Naloxone prescribing, defined as either a written prescription or a provided take-home kit, was assessed for all patients with OUD.

RESULTS

In 2019, 11,959 visits were made by 2962 unique patients with OUD, compared to 11,661 visits from 2,641 unique patients in 2020; 609 naloxone prescriptions were provided in 2019 (5.1%) and 619 in 2020 (5.3%). In both years, most OUD-related visits and naloxone prescriptions were from and to male, white, individuals. Compared with 2019, more naloxone prescriptions were given to uninsured patients in 2020 (33.2% vs 44.3%, p < 0.05), and more OUD patients were admitted to inpatient settings (26.0% vs 31.2%, p < 0.05) and received more naloxone prescriptions in the inpatient setting (46.3% vs 62.0%, p < 0.05) in 2020. The proportion of frequent users (i.e., visits ≥ 4 times/year) increased in 2020 for the emergency department (21.5% vs 26.4%, p < 0.001) and inpatient setting (24.9% vs 28.6%, p = 0.03).

CONCLUSIONS

Our findings indicate the need for improving naloxone awareness in providers and prescribing for patients with OUD, particularly in emergency department and outpatient settings. Our results also demonstrated a disparity in naloxone prescribing; a disproportionate number of opioid-related emergency department visits and overdose deaths were noted in Black people and frequent users.