A patient is treated for a prescription opioid overdose in the emergency department of a major medical center. What can the pharmacist do to limit the likelihood that the patient will overdose again?
For every fatal opioid overdose, there are 30 non-fatal overdoses, according to Julie Donohue, PhD, an associate professor of health policy and management at the University of Pittsburgh’s Graduate School of Public Health. So what can be done to improve the care of patients who overdose and survive?
“Evidence-based trials show that starting patients on addiction treatment medications in the emergency department is more effective than referring them to treatment and relying on them to follow-up with another provider within the health system,” commented Dr. Donohue. “Ultimately, addiction treatment needs to be integrated into the general medical setting instead of remaining in siloes that are separated from emergency departments and hospitals.”
Dr. Donahue said providers across all levels of care must ensure patients receive medication-assisted treatment and have their opioid prescriptions adjusted as needed after overdoses, patients are screened for opioid addiction in the ED and hospital settings and, when they’re referred to an addiction treatment center, someone on the care team is responsible for following up to ensure the appointments are made. Health-system pharmacists might be able help improve the care of these high-risk patients, according to Dr. Donohue, who said pharmacists play a vital role in examining prescribing patterns, particularly during transitions of care from inpatient or ED settings to outpatient care, and educating opioid prescribers on the appropriate prescribing of opioids as well as alternative forms of pain treatment.
“When patients are seen for an overdose, it’s a chance for the medical system to not only stabilize them, but engage them in addiction treatment programs when needed and take steps to reduce the likelihood of another overdose,” said Dr. Donohue. “Based on our recent study, I do not believe this opportunity is being fully realized.”
The study—which involved more than 6,000 patients who received treatment in an emergency department or hospital setting after overdosing on heroin or prescription opioids—showed 39.7% of patients who overdosed on heroin filled opioid prescriptions after overdosing, a drop of only 3.5% from before the overdose, and 59.6% of patients who overdosed on opioids filled prescriptions for opioids after the event, a decrease of just 6.5%.
Additionally, use of addiction treatment medications buprenorphine, methadone, or naltrexone increased slightly after the overdoses: one-third of patients treated for a heroin overdose received at least 1 dose after overdose and only 15% of patients who overdosed on prescription opioids received medication-assisted treatment.
According to Dr. Donohue, “That’s a relatively small response to patients who are at higher risk of future possibly fatal overdoses than other patients using opioids.”