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

• Published in: Prehospital and disaster medicine Vol. 36; no. 5; pp. 543 - 546
• Main Authors: Jenkins, Colin, Levine, Michael, Sanko, Stephen, Kazan, Clayton, Thomas, Caroline E., Eckstein, Marc
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.10.2021; Jems Publishing Company, Inc
• Subjects: Age; Central nervous system; Drug dosages; Drug overdose; Drug withdrawal; Emergency medical care; Emergency medical services; Fire departments; Fires; Health technology assessment; Hypoventilation; Narcotics; Original Research; Patients; Substance abuse treatment; Los Angeles County California; Los Angeles California; California; United States > US; overdose; naloxone; respiratory depression; Emergency Medical Services; opioid
• ISSN: 1049-023X; 1945-1938
• DOI: 10.1017/S1049023X21000820

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.