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The Review and Variation in Equitable Delivery of Emergency Naloxone

Author: Johnny Santini | |

Associate Authors: Bradley E. Dean | Sara E. Houston | Michael W. Hubble

Introduction

In recent years, studies have found varying degrees of disparity in naloxone administration in both prehospital and hospital medicine among different racial/ethnic groups. Among these studies, an inverse relationship was found in rural areas between opioid overdose occurrence and naloxone administration; that different minority groups are prescribed naloxone less often than other minority groups; and non-Hispanic Whites have 8 to 10 times greater access to naloxone. Naloxone doses of 0.4 and 0.8 mg have been shown to be safe and effective in managing opioid overdose. This study examines the occurrence of prehospital naloxone administration among different populations using national prehospital data.

Objective

To develop a model using a national prehospital dataset to determine if variations exist in prehospital naloxone administration during emergency services calls with a suspected opioid overdose.

Methods
A retrospective analysis was conducted on a nation-wide dataset from ESO Data Collaborative. The sample represented data from all calls for emergency services nationwide in the year 2020. Inclusion criteria consisted of any aged patients who were found responsive to tactile stimulus or unresponsive, with a respiratory rate of < 18 per minute and had a documented prehospital provider impression of an overdose. A logistic regression model was used to analyze the occurrence of administration of naloxone to prehospital patients of different ages, genders, races/ethnicities, respiratory rates, and levels of responsiveness.

Results

Of the 13,769 patients meeting inclusion criteria, there was no statistical significance between the rate of males (OR = 1.004, P = 0.179) or females receiving naloxone. Minorities, defined as any race other than White, were 29.6% more likely to receive naloxone (OR = 1.296, P < 0.001). While there was statistical significance for age, there was no clinical significance (OR = 1.008, P < 0.001). For each increase in respiration per minute increase, patients were 6.8% less likely to receive naloxone (OR = 0.932, P < 0.001). Finally, patients who were responsive to tactile stimulus were 59% less likely to receive naloxone than unresponsive patients (OR = 0.410, P < 0.001).

Conclusions

This retrospective analysis of a nationwide EMS database found that prehospital naloxone administration occurs more frequently for minority patients with congruent presentations than for nonminority patients. Further investigation is needed to identify potential reasons influencing variances in prehospital naloxone administration.