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West J Emerg Med. 2018 Nov;19(6):1036-1042. doi: 10.5811/westjem.2018.8.38829. Epub 2018 Sep 10.

The Emergency Department as an Opportunity for Naloxone Distribution.

Author information

Duke University, Duke-Margolis Center for Health Policy, Durham, North Carolina.
Duke University School of Medicine, Durham, North Carolina.
Duke Institute for Brain Sciences, Department of Psychiatry, Duke University, Durham, North Carolina.
Duke University School of Medicine, Division of Emergency Medicine, Durham, North Carolina.
Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan.
Duke University Hospital, Department of Pharmacy, Durham, North Carolina.
Campbell University College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Buies Creek, North Carolina.



Substance use disorders, including opioid use disorders, are a major public health concern in the United States. Between 2005 and 2014, the rate of opioid-related emergency department (ED) visits nearly doubled, from 89.1 per 100,000 persons in 2005 to 177.7 per 100,000 persons in 2014. Thus, the ED presents a distinctive opportunity for harm-reduction strategies such as distribution of naloxone to patients who are at risk for an opioid overdose.


We conducted a systematic review of all existing literature related to naloxone distribution from the ED. We included only those articles published in peer-reviewed journals that described results relating to naloxone distribution from the ED.


Of the 2,286 articles we identified from the search, five met the inclusion criteria and had direct relevance to naloxone distribution from the ED setting. Across the studies, we found variation in the methods of implementation and evaluation of take-home naloxone programs in the ED. In the three studies that attempted patient follow-up, success was low, limiting the evidence for the programs' effectiveness. Overall, in the included studies there is evidence that distributing take-home naloxone from the ED has the potential for harm reduction; however, the uptake of the practice remained low. Barriers to implementation included time allocated for training hospital staff and the burden on workflow.


This systematic review of the best evidence available supports the ED as a potential setting for naloxone distribution for overdose reversal in the community. The variability of the implementation methods across the studies highlights the need for future research to determine the most effective practices.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

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