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. 2024 Oct 1;7(10):e2439427.
doi: 10.1001/jamanetworkopen.2024.39427.

Layperson-Administered Naloxone Trends Reported in Emergency Medical Service Activations, 2020-2022

Christopher B Gage  1   2 , Jonathan R Powell  1   2 , Alexander Ulintz  3 , Rebecca E Cash  4 , Michael S Lyons  3 , Henry Wang  3 , Ashish R Panchal  1   2   3
Affiliations

Layperson-Administered Naloxone Trends Reported in Emergency Medical Service Activations, 2020-2022

Christopher B Gage et al. JAMA Netw Open. .

Abstract

Importance: Layperson-administered naloxone (LAN) is a powerful but incompletely characterized intervention to prevent opioid-related overdose mortality. LAN trends are relevant to policy and strategic planning in naloxone distribution initiatives.

Objective: To assess the 2-year LAN trend for persons in the United States receiving naloxone during emergency medical services (EMS) activations.

Design, setting, and participants: This retrospective cross-sectional study was conducted in the United States from June 2020 to June 2022 among 65 621 195 EMS activations from 911 responses, EMS standbys, or when EMS crews functioned in an ambulance intercept role or during mutual aid to another ambulance response. Activations within health care settings and interfacility or medical transports were excluded. Data are from the National Emergency Medical Services Information System (NEMSIS), the national EMS patient care record database. From June 2020 to June 2022, NEMSIS included more than 96 million EMS activations from nearly 14 000 agencies across 54 states and territories.

Exposures: EMS clinician-reported LAN.

Main outcome and measures: The primary outcome was the trend of receiving LAN, measured by EMS clinician documentation.

Results: From June 2020 to June 2022, EMS reported 744 078 patients receiving naloxone, with 24 990 (3.4%) involving LAN. Patients were predominantly male (17 331 [69.4%]) and had a median (IQR) age of 42 (31-56) years, with the majority treated in urban homes or residences (21 692 [86.8%] urban; 13 223 [52.9%] in-home or residence). Of the total naloxone recipients, 243 985 patients (32.8%) had suspected drug overdose documentation as either the primary or secondary impression. Overall, the percentage change in naloxone administration rates decreased 6.1% over the study period (from 1140.1 [95% CI, 1135.1-1145.1] per 100 000 EMS activations to 1070.1 [95% CI, 1064.9-1075.3] per 100 000 EMS activations), while the percentage change of persons receiving LAN increased 43.5% (from 30.0 [95% CI, 29.2-30.8] per 100 000 EMS activations to 43.1 [95% CI, 42.0-44.1] per 100 000 EMS activations).

Conclusions and relevance: In this cross-sectional study, the LAN rate increased from June 2020 to June 2022 as reported in the national EMS database. These findings help inform policies and practices aimed at mitigating the devastating impacts of the opioid epidemic and saving lives. Novel public health strategies are needed to measure the effects of this intervention nationally, evaluate approaches to expand naloxone distribution, and address naloxone usage barriers.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ulintz reported receiving grants from the Agency for Healthcare Research and Quality during the conduct of the study. Dr Wang reported receiving grants from the National Heart, Lung, and Blood Institute and Vasomune and receiving personal fees from the American College of Emergency Physicians outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram for Patient Inclusion and Exclusion Criteria From the Complete June 2020 to June 2022 National Emergency Medical Services Information System (NEMSIS) Dataset
Figure 2.
Figure 2.. Calculated Crude Rate of Monthly Layperson-Administered Naloxone Against Overall 911 Activations in the National Emergency Medical Services Information System dataset from June 2020 to June 2022
Each square data point signifies the observed crude rates of layperson-administered naloxone. aIndicates that the monthly percentage change (MPC) significantly differs from zero at the α < .05 level.
See this image and copyright information in PMC

References

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