Implementation of Oral and Extended-Release Naltrexone for the Treatment of Emergency Department Patients With Moderate to Severe Alcohol Use Disorder: Feasibility and Initial Outcomes

被引:16
作者
Anderson, Erik S. [1 ,2 ]
Chamberlin, Mac [1 ]
Zuluaga, Marisa [1 ]
Ullal, Monish [2 ,3 ]
Hawk, Kathryn [4 ]
McCormack, Ryan [5 ]
D'Onofrio, Gail [4 ]
Herring, Andrew A. [1 ,2 ,6 ]
机构
[1] Highland Hosp Alameda Hlth Syst, Dept Emergency Med, Oakland, CA 94602 USA
[2] Highland Hosp Alameda Hlth Syst, Dept Med, Subst Use Disorder Program, Oakland, CA 94602 USA
[3] Highland Hosp Alameda Hlth Syst, Dept Med, Div Primary Care, Oakland, CA 94602 USA
[4] Yale Univ, Sch Med, Dept Emergency Med, New Haven, CT USA
[5] NYU, Ronald O Perelman Dept Emergency Med, Grossman Sch Med, New York, NY USA
[6] Univ Calif San Francisco, Dept Emergency Med, San Francisco, CA 94143 USA
关键词
DEPENDENCE;
D O I
10.1016/j.annemergmed.2021.05.013
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objective: Despite evidence supporting naltrexone as an effective treatment for alcohol use disorder, its use in emergency department (ED) patients has not been described. We implemented a protocol that combined substance use navigation with either oral naltrexone or extended-release intramuscular naltrexone for patients with alcohol use disorder as a strategy to improve follow-up in addiction treatment after ED discharge. Methods: In this descriptive study, we analyzed the results from adult patients discharged from the ED with moderate to severe alcohol use disorder who received either oral naltrexone or extended-release intramuscular naltrexone between May 1, 2020, and October 31, 2020, and assessed their engagement in formal addiction treatment within 30 days after discharge from the ED. Results: Among 59 patients with moderate to severe alcohol use disorder who accepted naltrexone treatment, 41 received oral naltrexone and 18 received extended-release intramuscular naltrexone. The mean (SD) age of the patients was 45.2 (13.4) years; 22 patients (37.3%) were Latinx, 18 (30.5%) were Black, and 16 (27.1%) were White. Among all patients, 9 (15.3%) attended follow-up formal addiction treatment within 30 days after discharge; 5 patients (27.8%) who received extended-release intramuscular naltrexone and 4 patients (9.8%) who received oral naltrexone attended follow-up treatment within 30 days. Conclusion: We implemented a clinical protocol for ED patients with moderate to severe alcohol use disorder using oral naltrexone and extended-release intramuscular naltrexone together with substance use navigation. Identification of alcohol use disorder, a brief intervention, and initiation of naltrexone resulted in a 15% follow-up rate in formal addiction treatment. Future work should prospectively examine the effectiveness of naltrexone as well as the effect of substance use navigation for ED patients with alcohol use disorder.
引用
收藏
页码:752 / 758
页数:7
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