Opioid Overdose Reversal Drugs Underused by Laypeople

TOPLINE:

Emergency Medical Services (EMS)-reported naloxone administrations decreased by 6.1%, but layperson-administered naloxone (LAN) before EMS arrival increased by 43.5%.

METHODOLOGY:

• The study analyzed over 65 million EMS activations in the United States over a 2-year period starting in June 2020. Data were pulled from the National Emergency Medical Services Information System, a database of EMS patient care.
• Incident locations were recorded using International Classification of Diseases, Tenth Revision codes from the database and categorized as a residence, healthcare facility, non-healthcare business, street or highway, or other.
• LAN was characterized as any instance where naloxone was administered by a layperson before the arrival of EMS.
• The study excluded activations that occurred in healthcare settings, during interfacility or medical transports, as well as those where opioid analgesics were administered or no patient was found.

TAKEAWAY:

• Researchers found that naloxone was administered by laypersons in 24,990 cases, or 3.4% of total administrations, including those by EMS.
• The rate of people receiving LAN before EMS arrival increased over the study period by 43.5% from 30.0 to 43.1 per 100,000 EMS activations (95% CI, 29.2-30.8; 95% CI, 42.0-44.1), respectively.
• Naloxone administration rates overall dropped by 6.1%.
• Patients who received LAN were predominantly men (69.4%) with a median age of 42 years.
• The majority of LAN cases occurred in urban settings (86.8%) and in homes or residences (52.9%).

IN PRACTICE:

“This design highlights the uneven distribution and varying ease of naloxone use among the public. While an optimal harm-reduction approach would see bystander naloxone administration nearing 100%, our findings reveal a lower-than-ideal utilization rate accounting for only 3.4% of all EMS activations with naloxone administration,” the study authors wrote. “This gap underscores the imperative to not only improve naloxone education and access but also investigate other obstacles to its utilization in real-world contexts.”

SOURCE:

The study was led by Christopher B. Gage, MHS, of the National Registry of Emergency Medical Technicians in Columbus, Ohio. It was published online on October 14 in JAMA Network Open.

LIMITATIONS:

Mild overdose cases that did not require EMS assistance may not have been reported. Incomplete data entry within EMS records may have affected the reliability of the findings. Delays between EMS activation and data reporting could have introduced bias. The absence of a unified tracking system for naloxone administration outside of clinical environments may have hindered understanding of its usage patterns.

DISCLOSURES:

Various study authors reported receiving grants or personal fees from the Agency for Healthcare Research and Quality, the National Heart, Lung, and Blood Institute, Vasomune Therapeutics, and the American College of Emergency Physicians. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.