ABSTRACTS
Racial and Gender Disparities in Emergency Medical Services (EMS) Naloxone Treatment for Opioid OverdosesAuthor: Maria Beermann-Foat, PhD, NRP | | Associate Authors: Jamie Kennel, PhD, MAS, NRP, Charles Foat, PhD, NRP, Jewel W. Williams, DHSc, Jason W. Derrey, MA, EMT-P, Whitney Burr, David I. Page, MS, NRP
Introduction Preventable opioid deaths in the United States have quadrupled since 2010, totaling more than 80,000 U.S. deaths each year. EMS clinicians administering treatment in the out-of-hospital setting provide the best opportunity to perform life-saving interventions for individuals suffering from an opioid overdose. Unfortunately, there is evidence of racial and ethnic treatment disparities in EMS, although the evidence has largely been restricted to pain management practices. Objective To investigate racial and ethnic treatment inequities in naloxone administration in the setting of a suspected opioid overdose. Methods A retrospective analysis was performed on EMS encounters from 2021 in the ESO Data Collaborative. Cases included patients aged 18 years or older during a 9-1-1 ALS response where the provider entered a primary or secondary impression of opioid overdose. Descriptive and multivariable regression analysis was used to examine the role patient race and gender have on the administration of naloxone during an opioid overdose. Results A total of 75,692 EMS encounters met the inclusion criteria. All racial and ethnic minority patients studied and female patients were less likely to receive naloxone compared to White and male patients. Specifically, Black patients were 21% less likely (95% CI: 17–25%, p < 0.001), Asian patients were 62% less likely (95% CI: 49–71%, p < 0.001], and Hispanic patients were 12% less likely (95% CI: 6–17%, p < .001) when compared to White patients to receive naloxone. Further, female patients were 13% less likely (95% CI: 4–23%, p < .01) to receive naloxone when compared to their male counterparts. Conclusion During emergencies where the EMS clinician suspected the patient was suffering from an opioid overdose, clinicians were less likely to administer naloxone to racial and ethnic minority patients or to women. Naloxone administration represents a highly effective life-saving reversal agent for opioid overdose patients without any significant side effects, so it is concerning and unclear why this treatment disparity may exist. These findings contribute to the growing body of literature on racial and ethnic treatment disparities in EMS and should create urgency to develop evidence-based solutions so that all patients receive high-quality EMS treatment.
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