Ambulance-attended opioid overdoses: An examination into overdose locations and the role of a safe injection facility

Abstract

Background: Although the United States and numerous other countries are amidst an opioid overdose crisis, access to safe injection facilities remains limited. Methods: We used prospective data from ambulance journals in Oslo, Norway, to describe the patterns, severity, and outcomes of opioid overdoses and compared these characteristics among various overdose locations. We also examined what role a safe injection facility may have had on these overdoses. Results: Based on 48,825 ambulance calls, 1054 were for opioid overdoses from 465 individuals during 2014 and 2015. The rate of calls for overdoses was 1 out of 48 of the total ambulance calls. Males made up the majority of the sample (n = 368, 79%), and the median age was 35 (range: 18–96). Overdoses occurred in public locations (n = 530, 50.3%), the safe injection facility (n = 353, 33.5%), in private homes (n = 83, 7.9%), and other locations (n = 88, 8.3%). Patients from the safe injection facility and private homes had similarly severe initial clinical symptoms (Glasgow Coma Scale median =3 and respiratory frequency median =4 breaths per minute) when compared with other locations, yet the majority from the safe injection facility did not require further ambulance transport to the hospital (n = 302, 85.6%). Those overdosed in public locations (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.17–2.35), and when the safe injection facility was closed (OR =1.4, 95% CI =1.04–1.89), were more likely to receive transport for further treatment. Conclusions: Our findings suggest that the opening hours at the safe injection facility and the overdose location may impact the likelihood of ambulance transport for further treatment.

Keywords:

• Ambulance
• opioid overdoses
• overdose
• prehospital treatment
• safe injection facility
• supervised injection facility

Acknowledgments

The authors would like to thank the ambulance staff for their participation and assistance in data collection. We would also like to thank Thomas Draegni for his assistance with data entry.

Author contributions

Desiree Madah-Amiri had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the study concept and design. Arne Kristian Skulberg contributed to the acquisition of data. All authors contributed to the drafting of the manuscript. All authors contributed to the critical revision of the manuscript for important intellectual content and interpretation of results.