Naloxone Use by Emergency Medical Services During the COVID-19 Pandemic: A National Survey

Abstract

Objectives: The COVID-19 epidemic in the United States has hit in the midst of the opioid overdose crisis. Emergency medical services (EMS) clinicians may limit their use of intranasal naloxone due to concerns of novel coronavirus infection. We sought to determine changes in overdose events and naloxone administration practices by EMS clinicians. Methods: Between April 29, 2020 and May 15, 2020, we surveyed directors of EMS fellowship programs across the US about how overdose events and naloxone administration practices had changed in their catchment areas since March 2020. Results: Based on 60 respondents across all regions of the country, one fifth of surveyed communities have experienced an increase in opioid overdoses and events during which naloxone was administered, and 40% have experienced a decrease. The findings varied by region of the country. Eighteen percent of respondents have discouraged or prohibited the use of intranasal naloxone with 10% encouraging the use of intramuscular naloxone. Conclusions: These findings may provide insight into changes in opioid overdose mortality during this time and assist in future disaster planning.

Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review

“…Twenty studies met inclusion criteria and reported on changes in opioid-related outcomes in periods before vs after the onset of the COVID-19 pandemic (table 1). 14–32…”

Estimating naloxone need in the USA across fentanyl, heroin, and prescription opioid epidemics: a modelling study

“…30 Known but addressable barriers to expanding these pathways include funding constraints, overly restrictive laws around naloxone access through phar macies, and social stigma around obtaining naloxone. [31][32][33][34] Inherent to the more effective communitybased naloxone pathway is heavy reliance on peer social networks of people who use drugs, who are often undervalued in this context as being first responders. Communities could consider provision of mental health and crisis support for these responders and reducing or removing barriers to access to community naloxone to convey the value of services provided.…”

Emergency department utilization for substance use disorders and mental health conditions during COVID-19

“…However, emergency medical services (EMS) and syndromic surveillance data has suggested an increase in opioid overdoses during the early months of the pandemic. In some regions, this may reflect worsening access to substance use disorder (SUD) treatment options amidst state and local shutdowns or the psychosocial effects of COVID-19 that place people at higher risk of overdose or returning to use [3][4][5][6][7]. Prior to the identification of COVID-19, the US was facing the highest reported number of drug overdose deaths ever reported, with 72,224 drug overdose deaths provisionally reported by the CDC in the twelve months preceding January 2020 [8].…”