Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose

Zozula, Alexander; Neth, Matthew R.; Hogan, Andrew N; Stolz, Uwe; McMullan, Jason T.

doi:10.1080/10903127.2021.1884324

Cited by 25 publications

(17 citation statements)

References 17 publications

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“…EMS encounters among 15 years of age or older. Year-specific population estimates from Census tract [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…For example, Zozula et al. found that 40% of EMS encounters with naloxone administration in Cincinnati were missing data on race [ 20 ]. In our data, 19% of patients were missing a racial identification.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple non-fatal overdose encounters with the same person were treated as separate encounters and due to data restrictions for patient confidentiality, we did not identify how many individuals had one or more EMS encounters with naloxone administration. Other research indicates that repeat encounters are common, even during relatively short periods of time [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

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The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services

et al. 2022

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Introduction An estimated 100,306 people died from an overdose from May 2020 to April 2021. Emergency Medical Services (EMS) are often the first responder to opioid overdose, and EMS encounter records can provide granular epidemiologic data on opioid overdose. This study describes the demographic, temporal, and geographic epidemiology of suspected opioid overdose in Baltimore City using data from Baltimore City Fire Department EMS encounters with the administration of the opioid antagonist naloxone. Method The present analyses used patient encounter data from 2012 to 2017 from the Baltimore City Fire Department, the city’s primary provider of EMS services. The analytic sample included patient encounters within the city that involved naloxone administration to patients 15 years of age or older ( n = 20,592). Negative binomial regression was used to calculate the incidence rates based on demographic characteristics, year, and census tract. Choropleth maps were used to show the geographic distribution of overdose incidence across census tracts in 2013, 2015, and 2017. Results From 2012 to 2017, the annual number of EMS encounters with naloxone administrations approximately doubled every 2 years, and the temporal pattern of naloxone administration was similar to the pattern of fatal opioid-related overdoses. For most census tracts, incidence rates significantly increased over time. Population-based incidence of naloxone administration varied significantly by socio-demographic characteristics. Males, non-whites, and those 25–69 years of age had the highest incidence rates. Conclusion The incidence of naloxone administration increased dramatically over the study period. Despite significant cross-sectional variation in incidence across demographically and geographically defined groups, there were significant proportional increases in incidence rates, consistent with fatal overdose rates over the period. This study demonstrated the value of EMS data for understanding the local epidemiology of opioid-related overdose. Key Messages Patterns of EMS encounters with naloxone administration appear to be an excellent proxy for patterns of opioid-related overdoses based on the consistency of fatal overdose rates over time. EMS plays a central role in preventing fatal opioid-related overdoses through the administration of naloxone, provision of other emergency services, and transportation to medical facilities. EMS encounters with naloxone administration could also be used to evaluate the impact of overdose prevention interventions and public health services.

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“…EMS encounters among 15 years of age or older. Year-specific population estimates from Census tract [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services

et al. 2022

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“…The IACP guidance notes that jurisdictions need to develop protocols for when a person refuses further treatment or transport to the hospital in accordance with local and federal laws and regulations. Past research has demonstrated that further medical oversight or treatment of an overdose victim post naloxone administration is rarely necessary (Kolinsky et al,2016;Levine et al,2016;Vilke et al,2003;Wampler et al,2011;Willman et al,2017) though some have noted that those studies did not account for high potency synthetic fentanyl compounds that have been responsible for overdoses in recent years (Glober et al,2020) and others have found that refusal to be transported to the hospital post-naloxone administration was associated with subsequent non-fatal overdose (Zozula et al,2021). However, syringe services programs provided 702,232 naloxone doses to 230,506 persons in 2018 (Lambdin et al,2019), about 17% of which generally end up being used to reverse overdoses by lay persons (Wheeler et al,2015).…”

Section: Discussionmentioning

confidence: 99%

Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone

et al. 2022

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Background Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer’s perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. Methods The qualitative study examined officers’ experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. Results Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. Conclusion These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.

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“…Opioid Agonist Therapy (OAT) is described in this review as an emerging novel treatment option for paramedic care of PWUD. Although results are limited, early findings from pre-hospital OAT trials have been promising, illustrating that 100% of patients who were administered prehospital buprenorphine had an improvement of their opioid withdrawal symptoms, and many remained engaged in OAT at 30 days (49,50). Although buprenorphine is reported as a good "first step", the emphasis reported in these studies remains on the days following initial administration of OAT, ensuring patients are connected to continuing treatment and or support services (51) Further harm reduction opportunities for paramedics identified in this review include specialised community paramedicine, and oral fluid test illicit substance screening (52,53).…”

Section: Expanding Opportunities For Paramedic-led Harm Reductionmentioning

confidence: 99%

Substance Use and the Paramedic Role: A Scoping Review

Bolster¹,

Armour²,

O’Toole³

et al. 2023

Preprint

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Introduction: As the paramedic profession continues to grow and evolve, a shift from reactive to holistic patient care models is required. As the first and often the only point of medical contact for many patients from marginalized and under-served populations, the paramedic role, and its potential future implications in caring for these patients needs to be explored. Aim: The objective of this scoping review was to explore the paramedic's role in caring for people who use illicit drugs. Methods: A scoping review of English language literature published since 2002 was conducted using CINAHL, MEDLINE, EMBASE, and Google Scholar. We used a previously published paramedic search term filter for sensitivity combined with search terms related to drug-related substance use and addiction. Studies were selected based on relevance to the research question. Results: A total of 104 peer-reviewed and 14 grey literature articles were selected for inclusion. The main finding of this scoping review is the notable lack of evidence base surrounding the contemporary paramedic role in the care provision of people who use drugs (PWUD). The results highlight high rates of mortality following a paramedic-attended drug poisoning event, presenting a unique opportunity for paramedics to intervene in meaningful ways that extend past traditional drug poisoning response. Conclusions: The interface between the community of PWUD and the paramedic may be a highly influential encounter during a patient's journey through the healthcare system. The evolving role of the paramedic in this encounter requires focused study and should be viewed as a research priority in response to the ongoing drug poisoning crisis.

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Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose

Cited by 25 publications

References 17 publications

The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services

The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services

Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone

Substance Use and the Paramedic Role: A Scoping Review

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