Follow-up Care Vital to Keeping Survivors of Opioid Overdose Alive

Patients who survive opioid overdose are at high risk of death and should be offered counseling, buprenorphine, and follow-up care prior to discharge, said an emergency department physician at the annual meeting of the American College of Emergency Physicians (ACEP).

The results of an online survey of 1,261 emergency department (ED) physicians conducted this fall and presented at the meeting showed that 57 percent of ED doctors believe that detox and treatment facilities “are rare or not accessible” in their areas.

In fact, one of the greatest problems fueling the opioid crisis is the shortage of opioid treatment programs, said Paul Kivela, M.D., president of ACEP and managing partner of Napa Valley Emergency Medical Group.

“These patients are by no means ‘out of the woods.’ The opioid-overdose patient who sobers in the hallway [and] is offered a detox list and then discharged, has a 1 in 10 chance of being dead within one year,” Scott Weiner, M.D., director of the Comprehensive Opioid Response and Education Program at Brigham and Women’s Hospital in Boston, told conference attendees.

Weiner’s statement was based on an observational study he and colleagues in Boston conducted to determine one-year mortality of patients who received naloxone by emergency medical services (EMS) and initially survived. The researchers relied on data from three statewide datasets in Massachusetts: EMS, all payer claims, and death records.

Patients were included who received at least one naloxone administration by EMS between July 1, 2013, and December 31, 2015, and did not receive naloxone between January 1, 2013, and June 30, 2013.

Between July 1, 2013, and December 31, 2015, there were 12,192 EMS naloxone administrations in Massachusetts, or 406.4 per month. Death records showed that 6.5 percent of patients (787) died the same day they received naloxone, 9.3 percent (1,132) died within one year, and 84.3 percent (10,273) were alive at one year.

Opioid overdose was the listed cause of death for nearly 50 percent of those who died the same day and for 35 percent of those who died within one year. ■