Who receives naloxone from emergency medical services? Characteristics of calls and recent trends

Abstract

Background: With the rapid rise in opioid overdose-related deaths, state policy makers have expanded policies to increase the use of naloxone by emergency medical services (EMS). However, little is known about changes in EMS naloxone administration in the context of continued worsening of the opioid crisis and efforts to increase use of naloxone. This study examines trends in patient demographics and EMS response characteristics over time and by county urbanicity. Methods: We used data from the 2013–2016 National EMS Information System to examine trends in patient demographics and EMS response characteristics for 911-initiated incidents that resulted in EMS naloxone administration. We also assessed temporal, regional, and urban–rural variation in per capita rates of EMS naloxone administrations compared with per capita rates of opioid-related overdose deaths. Results: From 2013 to 2016, naloxone administrations increasingly involved young adults and occurred in public settings. Particularly in urban counties, there were modest but significant increases in the percentage of individuals who refused subsequent treatment, were treated and released, and received multiple administrations of naloxone before and after arrival of EMS personnel. Over the 4-year period, EMS naloxone administrations per capita increased at a faster rate than opioid-related overdose deaths across urban, suburban, and rural counties. Although national rates of naloxone administration were consistently higher in suburban counties, these trends varied across U.S. Census Regions, with the highest rates of suburban administration occurring in the South. Conclusions: Naloxone administration rates increased more quickly than opioid deaths across all levels of county urbanicity, but increases in the percentage of individuals requiring multiple doses and refusing subsequent care require further attention.

Keywords:

• Naloxone
• emergency medical services
• opioids
• drug overdose

Acknowledgements

The authors would like to thank Dr. N. Clay Mann for providing guidance and assistance with the primary data set. We also thank Ray Barrishansky for his valuable feedback on early versions of the article and Lynn Polite for assistance in manuscript preparation.

Author contributions

All authors were responsible for research question development and preparation of the manuscript. CG cleaned and prepared the data set and performed the statistical analysis with guidance from RS and BDS. All authors were responsible for interpretation of findings, organization of results, and critical revisions of the manuscript. All authors have reviewed and approve the final manuscript.

Additional information

Funding

This work was supported by the following grants from the National Institutes of Health: R21 DA045950-01 (Smart, PI) and P50 DA046351 (Stein, PI), both from the National Institute on Drug Abuse (NIDA). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA or the National Institutes of Health. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The authors declare they have no conflicts of interest.