Emergency Department-Initiated Interventions for Illicit Drug Overdose

Fatal and nonfatal overdoses (ODs) from illicit drugs continue to increase in U.S. emergency departments (EDs). Meanwhile, protocols that include best practices regarding interventions and discharge planning with this patient population remain inconsistent. A retrospective chart review was conducted with four EDs within one hospital system, during a 1-year period. There were N = 242 patient admissions for accidental, illicit, nonfatal drug ODs. Data regarding interventions, discharge planning, and education provided were extracted. Results included that primary drugs responsible for OD were opioids (e.g., heroin). The average length of stay in the ED was 2 hr and 25 min for stabilization and observation before discharge. Narcan was administered 70% of the time by either emergency medical services (EMS) or witnesses to the OD before the patient arrived at the ED. Drug information regarding opiates, sedatives, and stimulants was provided to patients 93% of the time. OD prevention education was provided 53% of the time. Narcan prescriptions were provided 25% of the time. Primary care provider (PCP) referrals were provided for 36% of patients, and 10% were referred to a medication-assisted therapy (MAT) treatment center. Although medication education was documented, there was no evidence found regarding specific MAT medications initiated in the ED. There were inconsistencies in what information was provided to patients at discharge. An evidence-based, standardized protocol for discharge should be identified for OD patients. This protocol should include four "gold standards," including planned follow-up with a PCP, OD prevention education, distribution of Narcan, and initiation of MAT when and where possible.