Prehospital Naloxone Administration Patterns during the Era of Synthetic Opioids

Abstract

Background: The opioid epidemic is an ongoing public health emergency, exacerbated in recent years by the introduction and rising prevalence of synthetic opioids. The National EMS Scope of Practice Model was changed in 2017 to recommend allowing basic life support (BLS) clinicians to administer intranasal (IN) naloxone. This study examines local IN naloxone administration rates for 4 years after the new recommendation, and Glasgow Coma Scale (GCS) scores and respiratory rates before and after naloxone administration.

Methods: This retrospective cohort study evaluated naloxone administrations between April 1^st 2017 and March 31^st 2021 in a mixed urban-suburban EMS system. Naloxone dosages, routes of administration, and frequency of administrations were captured along with demographic information. Analysis of change in the ratio of IN to intravenous (IV) naloxone administrations per patient was performed, with the intention of capturing administration patterns in the area. Analyses were performed for change over time of IN naloxone rates of administration, change in respiratory rates, and change in GCS scores after antidote administration. ALS and BLS clinician certification levels were also identified. Bootstrapping procedures were used to estimate 95% confidence intervals for correlation coefficients.

Results: Two thousand and ninety patients were analyzed. There was no statistically significant change in the IN/parenteral ratio over time (p = 0.79). Repeat dosing increased over time from 1.2 ± 0.4 administrations per patient to 1.3 ± 0.5 administrations per patient (r = 0.078, 95% CI: 0.036 − 0.120; p = 0.036). Mean respiratory rates before (mean = 12.6 − 12.6, r = −0.04, 95% CI: −0.09 − 0.01; p = 0.1) and after (mean = 15.2 − 14.9, r = −0.03, 95% CI: −0.08 − 0.01; p = 0.172) naloxone administration have not changed. While initial GCS scores have become significantly lower, GCS scores after administration of naloxone have not changed (initial median GCS 10 − 6, p < 0.001; final median GCS 15 – 15, p = 0.23).

Conclusions: Current dosing protocols of naloxone appear effective in the era of synthetic opioids in our region, although patients may be marginally more likely to require repeat naloxone doses.

Acknowledgments

The authors would like to thank Joseph DeAngelis and Travis White-Velez for operational insights in the prehospital field, Eric Wang for providing a template script, and Robert Lawlor, Anna Gasinski, and Anthony Tomassoni for valuable discussions.

Disclosure Statement

No potential conflict of interest was reported by the author(s).