番茄社区

WASHINGTON -- Almost 85% of patients administered naloxone by emergency services in Massachusetts lived for at least another year, according to a study presented here.

But that still meant 1-year mortality of 15%, and about 40% of those fatalities occurred later on the day they were resuscitated.

Emergency medicine physician Scott Weiner, MD, and colleagues at Brigham and Women's Hospital in Boston analyzed state-level data on 12,192 administrations of naloxone by emergency medical services. They found 6.5% died the same day they received the opioid reversal agent and 9.3% within the following 12 months -- many though not all from opioid overdoses.

Also, of the 1,132 dying within 1 year (excluding same-day deaths), 37.9% died outside a hospital, the researchers found. "That's a huge cohort that's dying before medical attention can get to them," Weiner said.

"These patients should be considered extremely high risk, and should receive interventions such as offering buprenorphine, counseling and referral to treatment prior to ED discharge," he said during his presentation at the American College of Emergency Physicians .

Opioid overdose was listed as the cause of death for 49.8% of patients who died the same day and 35.4% of those who died within one year.

About one-half of the documented deaths (again excluding same-day fatalities) occurred within one month of initial rescue. "That first month is very, very dangerous," Weiner said, noting that his team did not determine why.

Weiner's team conducted a retrospective observational analysis of data collected from July 2013-December 2015 from three public state sources, including emergency medical services, death records and payer claims. Patients were excluded if they had received naloxone during January-June 2013.

"Naloxone is working," Weiner said, citing the "quite high" one-day survival rate. "Naloxone is fundamental, but it's a Band-Aid, not a treatment."

Opioid users need better treatment overall, he said, suggesting more community access to naloxone, and education on how to administer naloxone for family and other potential caregivers. These patients struggle to care for themselves, let alone make it to their medical appointments: "Their brain is taken over by this disease. It's all-consuming," Weiner said. "We have to be able to match that need."

The researchers recommend buprenorphine, counseling, and referral prior to discharging patients from the ED based on their clinical experience, Weiner said. He recommended expanding access to recovery coaches (sometimes called "angels") and for providers to "start patients on buprenorphine right away."

EMS recorded a mean 406.4 naloxone administrations per month. Median age of the deceased was 54 (IQR 38-68) and 61% were male.

Study limitations included analysis of data from only one state via a database with limited and potentially erroneous information. It's also possible naloxone was administered to patients who did not overdose on opioids specifically; researchers had no access to data on comorbidities.

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