Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?

Vilke, Gary M.; Buchanan, Jean; Dunford, James V.; Chan, Theodore C.

doi:10.1080/10903129908958933

Cited by 60 publications

(37 citation statements)

References 4 publications

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“…Robust evidence has now established that harm reducing interventions like overdose prevention, better syringe access, and drug treatment do provide real health benefits to the IDU population and the broader community, including considerable savings in the use of public resources. 10,12,50,51 Side effects of naloxone administration and danger of overdose reversal have been found to be minimal, 19 and providers_ concerns about proper care can be addressed by bundling distribution programs with resuscitation and monitoring techniques. 8,13,19,41 A nasal delivery system can assuage provider anxiety about improper injection of the agent.…”

Section: Physicians Prescribing Naloxone To Reverse Opiate Overdosementioning

confidence: 99%

“…10,12,50,51 Side effects of naloxone administration and danger of overdose reversal have been found to be minimal, 19 and providers_ concerns about proper care can be addressed by bundling distribution programs with resuscitation and monitoring techniques. 8,13,19,41 A nasal delivery system can assuage provider anxiety about improper injection of the agent. 13,35 Communicating this evidence to physicians is the most immediate step to address the lack of knowledge and sense of treatment futility our survey highlights.…”

Section: Physicians Prescribing Naloxone To Reverse Opiate Overdosementioning

confidence: 99%

“…2,12,[15][16][17] Side effects associated with naloxone treatment for opiate overdose are generally rare. 12,18,19 Too often, timely medical attention is not provided to victims of opiate overdose. 5,11 Witnesses may fail to summon help for fear of legal repercussions to self or to the victim, or mistrust of the medical system.…”

Section: Introductionmentioning

confidence: 99%

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Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

et al. 2006

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Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a Btake-homed ose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

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Section: Physicians Prescribing Naloxone To Reverse Opiate Overdosementioning

confidence: 99%

Section: Physicians Prescribing Naloxone To Reverse Opiate Overdosementioning

confidence: 99%

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Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

et al. 2006

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“…Within 0 to 2 days of naloxone administration, the proportion of patients was 0 percent in three studies [71][72][73] (n=317, 552, and 998), one study 74 reporting one death (0.49% [1/205]), and one study 70 reporting 14 deaths (0.6% [14/2241]): three attributed to likely rebound overdose (0.13%), ten to new overdose, and one to a natural death. The final study reported one case of a life-threatening adverse event (1.2% [1/84]).…”

Section: Detailed Synthesismentioning

confidence: 99%

“…Although six studies reported low rates (0 to 1.2%) of death or serious adverse events among patients who received naloxone for opioid overdose and were not transported to a health care facility, [69][70][71][72][73][74] there was no comparison group of patients who were transported, and the studies provided limited details regarding the characteristics of the nontransported patients. This makes interpretation of findings difficult, as patients who refuse transport or are assessed as not requiring transport are likely to be at lower risk of opioid overdose-related complications than patients who are transported.…”

Section: Key Findings and Strength Of Evidencementioning

confidence: 99%

Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel

Chou¹,

Korthuis²,

McCarty³

et al. 2017

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Key Messages Purpose of ReviewTo determine optimal doses, routes of administration, and dosing strategies of naloxone for suspected opioid overdose in out-of-hospital settings, and whether transport to a hospital following successful opioid overdose reversal with naloxone is necessary. Key Messages• Higher concentration intranasal naloxone may be similarly effective and safe compared with intramuscular naloxone, but the available studies did not evaluate formulations approved by the Food and Drug Administration.• While field administration of naloxone is generally effective in reversing opioid overdose, there is not strong evidence concerning differences in effectiveness between doses or routes of administration.• More research is needed to determine optimal doses of naloxone, appropriate timing of repeat dosing, and whether it is necessary to dose patients to full consciousness.• More research is needed to determine whether transporting patients to a hospital after successful reversal of overdose is necessary.ii This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.This report may periodically be assessed for the currency...

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At‐risk patient documentation and naloxone dispersal for a rural statewide EMS “Naloxone Leave Behind” program

Naumann,

Benson,

Lamberson

et al. 2024

JACEP Open

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ObjectivesFor successful Naloxone Leave Behind (NLB) programs, Emergency Medical Services (EMS) must identify patients at‐risk for opioid overdose. We describe the first year of Vermont's NLB program and report rates of EMS documentation of at‐risk patients with subsequent distribution of NLB kits in the subgroup of those refusing transport to an emergency department (ED).MethodsThis retrospective cohort review of all EMS encounters over 1 year compared on‐scene EMS documented to retrospective chart reviewidentified at‐risk patients eligible for NLB kit dispersal. EMS was educated to identify at‐risk patients through statewide mandatory training modules. At‐risk patients were identified by electronic chart review using the same training criteria. As per protocol, patients identified as at‐risk by EMS who refuse ED transport are eligible for NLB. NLB‐appropriate patients by retrospective chart review without NLB protocol use documentation by EMS were considered “missed.”ResultsOf 110,701 EMS encounters, 2507 (2.4%) were at‐risk by chart review. Among these, 793 refused transport to an ED. In this chart‐review at‐risk non‐transported group, EMS documented 407 (51.3%) patients as at‐risk by documenting use of the NLB protocol. Of these 407, EMS provided 141 (34.6%) with NLB kits. Fifteen (3.7%) patients refused kits. There were 386 (48.7%) potentially “missed” opportunities for NLB dispersal.ConclusionEMS documented 51.3% of patients eligible for NLB dispersal, with 34.6% receiving kits. There was no documentation for 48.7% of chart‐review at‐risk patients, suggesting “missed” distribution opportunities. This study highlights the need for improved EMS identification of at‐risk patients, EMS documentation adherence, and NLB kit provision.

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Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?

Abstract: Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles.

Cited by 60 publications

References 4 publications

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel

At‐risk patient documentation and naloxone dispersal for a rural statewide EMS “Naloxone Leave Behind” program

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