(45) Evaluating Disparities in Prescribing of Naloxone After Treatment of Opioid Overdose

Background: Patients who are discharged after opioid-related overdose from emergency departments (EDs) are at high risk for mortality. Providing a naloxone rescue kit after overdose is recommended for harm reduction. Given the recent racial and ethnic disparities in opioid-related overdose and death reported in the literature, our health system aimed to evaluate the presence of disparities in prescription of naloxone following opioid overdose.

Methods: This was a retrospective cohort study of patients seen in our health system comprised of two large academic centers and eight community hospitals. Eligible patients had at least one visit to any of our hospitals’ EDs with a diagnosis code indicating opioid-related overdose in our system between May 1, 2018 and April 30, 2021. The primary outcome measure was prescription (including written prescription or dispensation) of a nasal naloxone kit from the ED during at least one visit for opioid-related overdose during the study period in which the patient was discharged. A multivariable logistic regression model determined the association of demographics with the naloxone prescription outcome.

Results: During the study period, there were 1,348 unique patients who presented 1,593 times to one of the EDs with opioid overdose. Six patients were excluded from further analysis because of missing values in the age variable. Of included patients, 580 (43.2%) received at least one prescription for naloxone. The majority (68.9%, n=925) were male. The most common age group was 35-44 years (31.4%, n=422). For race/ethnicity: 74.5% (1,000) were non-Hispanic White, 8.0% (n=108) were non-Hispanic Black, and 13.0% (n=175) were Hispanic/Latinx. The remainder were other or unknown. Compared with the reference age group of 16-24 years, only those 65+ were less likely to receive naloxone (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.84). There was no difference for gender (male OR 1.23, 95% CI 0.97-1.57 compared to female). Hispanic/Latinx patients were more likely to receive a prescription when compared to non-Hispanic White patients (OR 1.72, 95% CI 1.22-2.44), while there was no difference between non-Hispanic Black compared to non-Hispanic White patients (OR 1.31, 95% CI 0.87-1.98).

Conclusions: Naloxone prescribing after overdose in our system’s EDs was suboptimal, with fewer than half of patients with an overdose diagnosis code receiving this lifesaving and evidence-based intervention. Patients who were Hispanic/Latinx were more likely to receive it than other race and ethnicity groups, and patients who were older were less likely to receive it, findings which warrant attention and are being shared with providers in our health system. Further evaluation of reasons for differences in naloxone prescribing by ethnicity and age could validate these findings and guide future interventions to improve naloxone access.

References: Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2020 Jan;75(1):13-17.

Patel I, Walter LA, Li L. Opioid overdose crises during the COVID-19 pandemic: implication of health disparities. Harm Reduct J. 2021 Aug 16;18(1):89.

Friedman J, Mann NC, Hansen H, Bourgois P, Braslow J, Bui AAT, Beletsky L, Schriger DL. Racial/Ethnic, Social, and Geographic Trends in Overdose-Associated Cardiac Arrests Observed by US Emergency Medical Services During the COVID-19 Pandemic. JAMA Psychiatry. 2021 Aug 1;78(8):886-895.

Moustaqim-Barrette A, Dhillon D, Ng J, Sundvick K, Ali F, Elton-Marshall T, Leece P, Rittenbach K, Ferguson M, Buxton JA. Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review. BMC Public Health. 2021 Mar 26;21(1):597.

Reddy NG, Jacka B, Ziobrowski HN, Wilson T, Lawrence A, Beaudoin FL, Samuels EA. Race, ethnicity, and emergency department post-overdose care. J Subst Abuse Treat. 2021 Aug 5:108588.

Diversity, Equity, and Inclusion: The key motivation to perform this study was to determine any health disparities present in prescribing of naloxone after overdose. Although our hypothesis that non-White patients would be less likely to receive naloxone was not true, we did discover that prescribing was sub-optimal for all groups, and particularly for older patients. We encourage conference participants to evaluate their own data to determine if such disparities are present in their system.