Article Bites: How often do they get more than one? Naloxone redosing in the age of the opioid epidemic

BLS and law enforcement naloxone administration improves already stretched EMS systems management of increased opioid overdoses

This article originally appeared in the Article Bites blog of the National Association of EMS Physicians and is reprinted here with permission.

By Al Lulla, M.D., NAEMSP Article Bites Editor

Article Reviewed: Klebacher R, Harris MI, Ariyaprakai N, et al. Incidence of Naloxone Redosing in the Age of the New Opioid Epidemic. Prehosp Emerg Care. 2017;21(6):682-687.

Background & objectives. The surging opioid epidemic has largely been combated with the use of intravenous and intramuscular naloxone administration. More recently, intranasal naloxone has been shown to be easily administered by not only EMS providers, but also law enforcement and family members to help reverse potentially fatal overdoses. Recently, mixed overdoses and ingestions with far more potent agents (such as carfentanil) are on the rise, necessitating repeat naloxone dosing. The primary objective of this study was to determine the incidence of repeat naloxone administration for patients with suspected opioid overdose. The secondary endpoint was a more detailed descriptive and statistical analysis evaluating the precise characteristics associated with individuals who required repeat naloxone dosing.

Methods. The investigators conducted a retrospective chart review of the electronic health record of the largest EMS service in New Jersey. Charts were searched for the presence of naloxone administration and other key words including “drug overdose,” “poisoning,” and “unresponsive.” Charts were examined between April 2014 and June 2016. In order to be included in the study, patients had to be over the age of 17 years and administered an initial dose of 2mg of intranasal naloxone. Initial naloxone administration was performed by law enforcement or a BLS unit per New Jersey state regulations. Subsequent doses of naloxone were administered by ALS units. Resolution or response to therapy was defined as GCS of 15. In addition, demographic data was extracted from each patient encounter. 

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