Audit of near-fatal overdoses (NFOs) in patients on treatment via substance misuse services (SMS)

Abstract

Introduction

In the NHS Forth Valley (Central Scotland) substance misuse service (SMS), there is an arrangement whereby the details of individuals administered naloxone for overdose via the ambulance service are passed to the SMS. Each patient has an allocated keyworker (nurse). It is accepted that near fatal overdoses (NFOs) are possible precursors to fatal overdose and drug-related deaths.

Objectives

To assess:

– if the information is being disseminated appropriately;

– service response and follow-up for individuals;

– patterns which might influence prescribing practice.

Methods

A list of NFOs of known patients for the previous two years was acquired from the ambulance service. There was a retrospective review of the SMS prescribing database and clinical casenotes.

Results

Patterns:

– 81% male;

– 53% aged < 40;

– 14% of NFO's involved those in titration phase;

– 86% were prescribed methadone. Methadone average dose 57 mg (20–80 mg) and 54% were prescribed > 60 mg/day.

Receipts of information:

– sixty-one percent of keyworkers were notified.

Service response:

– in most cases when the keyworkers was informed, there was prompt action to contact and review patients (0–21 days). However, only 21% had a timely review (within 1 month) by a doctor following NFO.

Conclusion

There needs to be an improvement in the dissemination of information between the ambulance service, administrative staff and keyworkers. Most NFO patients were prescribed > 60 mg of methadone. There needs to better identification of “harm-reduction” prescribing whereby methadone doses should be reduced at times of ongoing drug use. Fourteen percent of NFO's involved those in titration phase (twice weekly reviews) which provides an opportunity to screen and intervene for potential NFOs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.