Opioid addicts saved by the overdose reversal medication naloxone are still in danger following their close brush with death, a new study shows. About 10% of overdose patients saved with naloxone (Narcan, Adapt Pharma, Inc.) in Massachusetts hospitals ended up dying within a year, Harvard researchers reported. In addition, half of those who died did so within a month of their rescue.
“The opioid overdose patient who sobers in the hallway, is offered a detox list, and then is discharged has a one-in-10 chance of being dead within one year, and their highest risk is within the first month,” said lead researcher Scott Weiner, MD, MPH. Weiner is Director of the Comprehensive Opioid Response and Education Program at Brigham and Women’s Hospital in Boston.
Patients saved with naloxone are very likely to suffer withdrawal cravings that could drive them to overdose within a matter of weeks, he said.
“Naloxone is not the panacea solution to the crisis,” Weiner said. “Patients who survive opiate overdose need to be considered extremely high risk and should receive interventions like offering buprenorphine or offering counseling and referral for treatment prior to discharge from the emergency department.”
The United States is in the grip of an opioid epidemic. Since 1999, the number of overdose deaths involving opioids—including prescription painkillers such as OxyContin (oxycodone hydrochloride, Purdue Pharma) and Vicodin (hydrocodone bitartrate and acetaminophen, AbbVie), as well as heroin—have quadrupled. Ninety-one Americans now die every day from an opioid overdose.
Public health officials have been pressing for the widespread availability of naloxone, which is the first approved medication for the reversal of an opioid overdose. But without follow-up care, patients saved by naloxone will remain addicted, experts warn.
To assess the risk of death in these patients, Weiner and colleagues combined statewide Massachusetts databases that track emergency medical services (EMS), insurance claims, and death records.
From July 2013 through December 2015, EMS workers in the state used naloxone nearly 12,200 times to treat a drug overdose. About 10% of those who survived wound up dying within one year of treatment, Weiner said. One-third of those deaths were directly attributed to opioid overdose, but prescription painkillers probably played a hand in many more than indicated, he suggested.
“If someone dies from an overdose, first their breathing stops and then their heart stops, so you might have the cause of death listed as cardiopulmonary arrest,” Weiner said. “If they don’t code that it’s opioid-related then we wouldn’t capture that, so I think the opioid-related deaths are grossly underestimated in our dataset.”
“Once we save them, then we need to talk seriously about the next steps,” Weiner said. “There have been several innovative models where they actually start buprenorphine or Suboxone [buprenorphine and naloxone, Indivior] directly in the ED [emergency department], and get people to not suffer the withdrawal symptoms that often make them leave and start using again.”
“But even that’s not enough,” Weiner continued. “We need a follow-up system after that, a warm hand-off” between the ED and addiction treatment services.
The study results were presented at the American College of Emergency Physicians annual meeting in Washington, D.C. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.
Source: HealthDay News; October 30, 2017.