Assessment for Deaths in Out‐of‐hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Abstract

Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.

Risk factors for 48-hours mortality after prehospital treatment of opioid overdose

“…In our study the median age for overdose was 34 years, similar to some previous studies 1 10. Most other studies report a younger median age 7 11–17.…”

“…Most patients recover quickly after being ventilated and receiving an opioid antagonist, but the prognosis is influenced by the high frequency of drug abuse and poor socioeconomic status 1 2. Admission to hospital after treatment may allow careful observation but drug addicts are quite often not motivated for hospitalisation and some medical emergency systems, including ours, allow patients to be discharged immediately at the physician's discretion after a short observation period.…”

“…Admission to hospital after treatment may allow careful observation but drug addicts are quite often not motivated for hospitalisation and some medical emergency systems, including ours, allow patients to be discharged immediately at the physician's discretion after a short observation period. The group of drug abusers appreciates this policy, but there is a risk of recurrence toxicity and other morbidity 1 3–6. We have previously described three cases of likely fatal rebound toxicity in this group of drug addicts over 10 years 6.…”

Family carers and the prevention of heroin overdose deaths: Unmet training need and overlooked intervention opportunity of resuscitation training and supply of naloxone

“…The summoning of emergency medical care is particularly important as the naloxone will block the effects of the heroin (or other opiate) for between half an hour to an hour (Chamberlain & Klein, 1994;Sporer, 1999) after which there is a risk of gradual return of the overdose-although it is likely that the more severe respiratory depression of the acute heroin administration will have passed. This is probably the explanation for the lack of any reported overdose deaths in heroin users who discharge themselves from ambulances or hospital against medical advice after receiving a naloxone injection (Vilke, Buchanan, Dunford, & Chan, 1999;Vilke, Sloane, Smith, & Chan, 2003). Also all medications, particularly when given by injection, can cause unexpected untoward reactions although these are rare and a sense of perspective must be preserved when considering these possibilities against a situation where overdose death seems imminent.…”

A prehospital treat-and-release protocol for supraventricular tachycardia

“…[10][11][12][13][14] The medical conditions for which T + R protocols have been previously described are acute hypoglycemia [12][13][14] and opioid overdoses. 10,11 The widespread implementation of T + R protocols for other conditions has not yet occurred. This may be due to safety concerns surrounding non-transport of patients and a lack of empirical evidence assessing their effectiveness, efficiency, and safety.…”