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J Emerg Med. 2019 Apr;56(4):378-385. doi: 10.1016/j.jemermed.2018.12.029. Epub 2019 Feb 13.

Results of a Naloxone Screening Quality-Improvement Project in an Academic Emergency Department.

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School of Medicine, University of California San Diego, La Jolla, California.
Department of Pharmacy, University of California San Diego Health, San Diego, California.
Scripps Translational Science Institute, La Jolla, California; Department of Pediatrics, University of California, San Diego, San Diego, California.
Department of Emergency Medicine, University of California San Diego Health, La Jolla, California.
Department of Pharmacy, University of California San Diego Health, San Diego, California; Doris A. Howell Palliative Teams, University of California San Diego, La Jolla, California.



The Emergency Department (ED) is a medical setting increasingly utilized by opioid users. In January 2016, our health system initiated a take-home naloxone education and distribution program. From July to August 2016, screening was performed in the ED to identify patients for take-home naloxone.


To evaluate the outcomes of routine screening for take-home naloxone in the ED setting and to determine key screening questions. Secondary analysis of Electronic Health Records for discrete elements that could help identify individuals for naloxone.


This is a single-center, retrospective cohort study conducted at two EDs within an academic health system. A screening tool was verbally administered to a convenience sample of ED patients as part of a pilot project to identify patients for overdose education and naloxone. Patient charts were reviewed retrospectively for pre-determined historical elements, medications prescribed, and substance use history. Descriptive and comparative analysis using Fisher two-tailed tests were performed with regard to historical elements, naloxone recommendation and prescription.


A total of 182 patients were included. Following screening, 58 (31.9%) were identified as candidates for take-home naloxone. Of those, 36 (62.1%) accepted naloxone recommendation and 19 (32.8%) were prescribed naloxone. Individuals not prescribed naloxone despite recommendation either declined naloxone 22 (37.9%) or were not prescribed naloxone 17 (29.3%). Subanalysis of questions with binary yes/no answers (N = 171) demonstrated significant prediction of both naloxone recommendation (ROC = 0.944) and prescription (ROC = 0.897).


Routine screening for take-home naloxone can help identify patients at-risk for opioid overdose and increase naloxone access in the ED.


harm reduction; opioid overdose; opioids; take-home naloxone

[Indexed for MEDLINE]

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