Use of Naloxone in 9-1-1 Patients without Respiratory Depression in Los Angeles County, California (USA)

Abstract

Introduction: Along with an increase in opioid deaths, there has been a desire to increase the accessibility of naloxone. However, in the absence of respiratory depression, naloxone is unlikely to be beneficial and may be deleterious if it precipitates withdrawal in individuals with central nervous system (CNS) depression due to non-opioid etiologies. Objective: The aim of this study was to evaluate how effective prehospital providers were in administering naloxone. Methods: This is a retrospective study of naloxone administration in two large urban Emergency Medical Service (EMS) systems. The proportion of patients who had a respiratory rate of at least 12 breaths per minute at the time of naloxone administration by prehospital providers was determined. Results: During the two-year study period, 2,580 patients who received naloxone by prehospital providers were identified. The median (interquartile range) respiratory rate prior to naloxone administration was 12 (6-16) breaths per minute. Using an a priori respiratory rate of under 12 breaths per minute to define respiratory depression, only 1,232 (47.8%; 95% CI, 50.3%-54.2%) subjects who received naloxone by prehospital providers had respiratory depression. Conclusion: This study showed that EMS providers in Los Angeles County, California (USA) frequently administered naloxone to individuals without respiratory depression.

Does Housing Status Matter in Emergency Medical Services Administration of Naloxone? A Prehospital Cross-sectional Study

“…We chose to define respiratory depression a priori as bradypnea with a respiratory rate of less than 12 breaths per minute, based on the LA County EMS Agency protocol and prior work evaluating prehospital naloxone administration. 28 , 29 Although respiratory depression may also present as hypopnea, it is subjective and not reliably documented in the prehospital care report.…”

“…Our model included age categories, gender, and clinical indication of respiratory depression because these factors were shown to have an effect in prior literature. 20 , 29 The logistic regression formalized this, allowing us to test whether observed differences by PEH status were 1) reducible to clinical need or 2) reducible to other demographics. The logistic regressions do not provide a complete model of all possible explanations or establish causality, but rather help rule out alternative explanations of scientific and policy significance and to quantify important effects.…”