Implementation of an EMS‐based naloxone distribution program: A qualitative evaluation

• Published in: Journal of the American College of Emergency Physicians Open Vol. 5; no. 5; p. e13300
• Main Authors: Ager, Emily E., Purington, Ella K., Purdy, Megan H., Benenati, Brian, Baker, Jessica E., Schellack, Christine Jane, Smith, Graham C., Hunt, Nathaniel R., Losman, Eve D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2024; John Wiley & Sons, Inc; John Wiley and Sons Inc; Elsevier
• Subjects: addiction; Attitudes; Consent; Data analysis; Drug overdose; Drug use; Education; Emergency medical care; Emergency services; EMS; First responders; Gift cards & certificates; Harm reduction; Injury Prevention; Interviews; leave‐behind naloxone; naloxone; Narcotics; Original Research; Paramedics; Patients; Qualitative research; substance use; United States > US; Livingston County Michigan; Michigan; substance use; naloxone; leave‐behind naloxone; EMS; addiction; harm reduction
• ISSN: 2688-1152; 2688-1152
• DOI: 10.1002/emp2.13300

We evaluated a novel leave‐behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD). We conducted telephone interviews with EMS personnel and residents of substance use recovery housing between February and September 2023. EMS personnel described their direct experiences with the LBN program and perceived facilitating factors and barriers to naloxone distribution. First responder interactions and support for LBN were explored with PWUD. A rapid assessment method was used to analyze the interview data. Eighteen of the 23 EMS participants had distributed LBN; most agreed EMS agencies should have an LBN program. Barriers included forgetting, patient acuity, patients declining, and perceived liability. Facilitators included having a clear protocol, accessible kits, and minimal documentation burden. The majority expressed interest in harm reduction education. Eight of the 11 PWUD participants reported recent involvement in an opioid overdose. The majority supported LBN and felt comfortable receiving naloxone training from EMS. In this qualitative evaluation, we found broad support for EMS‐based naloxone distribution among EMS personnel and PWUD. We identified several modifiable barriers to the success of such programs, which should be the subject of future investigation. EMS and harm reduction communities should support the expansion of LBN programs across the United States.