Maureen Salamon

October 31, 2017

WASHINGTON, DC — About 10% of people who overdose on opioids and are treated with naloxone die within a year, new research shows.

The reason for the study was to get a concrete statistic to share with people who overdose that would spur them to get help for their addiction, which the "vast majority" don't seek, said investigator Scott Weiner, MD, director of the comprehensive opioid response and education program at Brigham and Women's Hospital in Boston.

"Now I tell patients that you have a one in 10 chance you will be dead within a year," he told Medscape Medical News. "I want it to hit home. I want them to understand the scope of the problem."

Dr Weiner and his colleagues tracked more than 12,000 naloxone administrations in Massachusetts over 30 months, which averages out to about 406 each month.

Of the people who received the opioid overdose antidote from emergency medical services personnel, 6.5% died the same day, Dr Weiner reported here at the American College of Emergency Physicians (ACEP) 2017 Scientific Assembly.

Just under 10% of people who received naloxone died within a year, and half of those died within a month.

And of those who died within a year, about 40% died outside a hospital.

"That, to me, means that people are dying before healthcare can get to them," Dr Weiner explained. These are the people who using opioids at home, by themselves, and are found dead. "That's where bystander naloxone needs to come into play. If friends and family know someone is using, they need to have naloxone."

Congress is considering legislation that would allow naloxone to be sold over the counter, which makes sense because naloxone "is a much safer medication than Tylenol," he pointed out. Currently, the loved ones of opioid users can obtain it through a physician's standing order, but "it's still a little circuitous."

People who abuse opioids should be considered to be at extremely high risk, and should receive interventions — such as buprenorphine, counseling, and referral to treatment — before they are discharged from the hospital, he added.

A related study presented at the meeting indicates that more than half the patients who present to the emergency department with opioid misuse problems suffer from mental health issues and high rates of early childhood trauma exposure.

Results from a recent ACEP poll of 1261 emergency physicians suggest that the number of patients seeking opioids in emergency departments has increased or remained the same in the past year.

Virtually every emergency physician in the country is affected by the opioid crisis, said ACEP President Paul Kivela, MD, from the Napa Valley Emergency Medical Group in California, who presented the poll results.

According to 57% of respondents, detox and rehabilitation facilities are rarely or never accessible, which leads to few referral options.

"It's been a problem for a long time, and the majority of emergency physicians out there say there are no treatment programs for these patients," said Dr Kivela. "We need to expand our capabilities or scope of care."

He said he is pleased that President Trump has declared the opioid crisis a public health emergency, and hopes the federal government will provide financial and other resources to help tackle the epidemic.

It's heartbreaking and shameful that people who genuinely want help can't get it.

The study findings and poll results are "extremely relevant" to what emergency physicians experience every day, said Angela Mattke, MD, from US Acute Care Solutions in Cleveland.

Several years ago, she handled about one opioid overdose each month, she told Medscape Medical News. "Now I see several a shift."

"Because naloxone is now so widely available, I'm seeing fewer overdoses," she added. "Frequently, I do have patients who would like addiction treatment, but there are no resources available. It's heartbreaking and shameful that people who genuinely want help can't get it."

Dr Weiner is a shareholder and member of the scientific advisory board for General Emergency Supplies and Epidemic Solutions. Dr Kivela and Dr Mattke have disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2017 Scientific Assembly: Abstract 402. Presented October 30, 2017.

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