Catch and release: evaluating the safety of non-fatal heroin overdose management in the out-of-hospital environment

Abstract

Background: The aim of this study was to investigate the safety of the management of non-fatal heroin overdose in the out-of-hospital environment; irrespective of whether or not naloxone had been administered. Heroin toxicity-related deaths as well as heroin intoxication-related traumatic deaths following patient-initiated refusal of transport were investigated.

Methods: Heroin-related deaths in the state of Victoria, Australia between 1 January 2012 and 31 December 2013 were investigated and data linkage to pre-hospital Emergency Medical Services performed, in order to identify whether the death was related to the last episode of care by paramedics. The number of non-fatal heroin overdose events over the study period were also examined.

Results and discussion: There were a total of 3921 heroin-related attendances by paramedics during the study period, including 2455 cases that involved treatment but where the patient was not transported to hospital. There were also 243 heroin-related deaths identified over the study period and 93% (n = 225) of those cases were matched with Ambulance Victoria electronic patient care records. Data linkage revealed 31 heroin-related deaths where there had been a recent presentation with a non-fatal heroin overdose to paramedics; however, none of these deaths were related to that episode of care, including for 11 individuals that were treated on scene by paramedics but not transported to the hospital.

Conclusions: This study demonstrated that the treatment of uncomplicated heroin overdose in the out-of-hospital environment was safe in terms of mortality, irrespective of whether or not naloxone had been administered. In all of the non-fatal heroin toxicity cases attended by paramedics, whether or not transported to hospital, death occurred as a result of a subsequent and unrelated heroin overdose.

Keywords:

• Heroin toxicity
• heroin overdose
• treat-and-release
• naloxone

Acknowledgements

The authors acknowledge the staff of the Victorian Institute of Forensic Medicine, the Coroners Court of Victoria, the National Coronial Information System and Ambulance Victoria for generously providing data, advice and assistance for this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

NS was supported by an Australian Government Research Training Program Scholarship. This research did not receive any other specific grant or funding from agencies in the public, commercial, or not-for-profit sectors.