Trends in naloxone prescribed at emergency department discharge: A national analysis (2012-2019).

BACKGROUND: While having access to naloxone is recommended for patients at risk for opioid overdose, little is known about trends in national naloxone prescribing rates in emergency departments (EDs) both for co-prescription with opioids and for patients who presented with opioid abuse or overdose. This study aims to evaluate the change in naloxone prescribing and opioid/naloxone co-prescribing at discharge using national data. METHODS: We conducted an IRB exempt retrospective review of data collected by the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. The primary outcome was trend in rate of naloxone prescribing at discharge from ED visits. We also computed the proportion of visits where naloxone was both administered in the ED and prescribed at discharge, where naloxone and opioids were co-prescribed at discharge, and where an opioid was administered during the ED visit and naloxone was prescribed at discharge. All data were summarized using descriptive statistics and Spearman's Rho (SR) or Pearson's correlation (PR) were used to describe trends. RESULTS: There was an estimated total of 250,365 patient visits where naloxone was prescribed at discharge with an increasing rate over time (0% of all ED visits in 2012 to 0.075% in 2019, p = 0.002). There were also increases in naloxone being both administered in the ED and prescribed at discharge (PC: 0.8, p = 0.02) as well as in naloxone and opioid co-prescribing (SR: 0.76, P = 0.03). There was an increase in utilization of opioids during the ED visit and naloxone prescribing at discharge for the same visit (SR: 0.80, p = 0.02). CONCLUSION: There are increases in naloxone prescribing at discharge, naloxone and opioid co-prescribing, and opioid utilization during the same visit where naloxone is prescribed at discharge. Future studies should be done to confirm such trends, and targeted interventions should be put into place to increase access to this life-saving antidote.

The impact of COVID-19 on analgesic prescribing in an urban emergency department.

BACKGROUND: Providers across the country have significantly decreased opioid prescribing over the past decade to prevent opioid misuse. The COVID-19 pandemic led to a disruption of the healthcare system and changes in the relationships between patients and providers. Consequently, we sought to investigate whether the pandemic had any impact on analgesic prescribing in an urban emergency department. METHODS: This was a retrospective, single center study analyzing pharmacy records of patients that were treated with analgesics between January 2019 and May 2021. The most common analgesics utilized were tallied by month. Utilization of specific analgesics were compared between T1-pre-COVID-19 (1/2019-1/2020) and T2-post-COVID 19 (5/2020-5/2021). Analgesics were also categorized into broader categories (such as IV, oral, opioid, and non-opioid) and compared. Comparisons were analyzed using the t-test, Mann-Whitney u test, or chi-squared difference of proportions tests, as applicable. RESULTS: There were significant decreases in the amount of IV (7.2% vs. 6.5; p = 0.039) and oral opioid (2.6% vs. 2.1%; p = 0.001) administered during COVID-19. There were also decreases in the percent of patients given opioids (T1: 6.7 vs. T2: 4.6, p < 0.001). During COVID, there was an increase in the amount of non-opioid analgesics given per patient (p = 0.013). Particularly, there was an increase in the amount of oral non-opioid administrations per patient (p = 0.005). There was a decrease in utilization of ibuprofen between the two time periods (p < 0.001). CONCLUSIONS: Despite the pandemic, providers continued to decrease opioid prescribing and increase non-opioid prescribing.

The Poison Center as a pandemic response: establishment and characteristics of a COVID-19 hotline through the New Jersey Poison Center.

BACKGROUND: Poison Centers are uniquely positioned to respond to an unprecedented public health threat such as the COVID-19 pandemic, as fully operational 24-h hotlines already staffed with healthcare professionals. METHODS: On January 27, 2020 the New Jersey Poison Information and Education System (NJPIES) agreed to operate the New Jersey Coronavirus Hotline. Call patterns, subject matter, and staffing and infrastructure strategies that were implemented to meet the demand are described. In addition, a sample of 1500 individual calls were collected and analyzed in an endeavor to describe call times, call days, area from which the call originated, callers to the hotline, primary language of the caller, and why a call was placed to the hotline. Binomial regression analysis was utilized in an attempt to identify significant patterns. RESULTS: Since the inception of the hotline through October 31, NJPIES responded to 57,579 calls for COVID-19 information. Most calls (68.7%) were regarding testing for COVID-19 and for general questions/symptoms. Call types varied when they were analyzed by time of day with calls for general questions/symptoms and where to get tested for COVID-19 showing a significant association for the early morning hours, how to obtain test results being significantly associated with the afternoon hours, and how to renew or obtain a medical license showing a significant association to the evening hours. We additionally noted that specific call types became significant when analyzed on a week-to-week basis and as specific events, like the enactment of the CARES Act of 2020, occurred. CONCLUSION: Although not the traditional role of a regional Poison Control Center, pandemic response synergizes with the workflow of this hotline because the infrastructure, staffing, and healthcare expertise are already present. Poison centers can rapidly adapt through scaling and process change to meet the needs of the public during times of public health threats.