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

Published online by Cambridge University Press:  24 August 2021

Colin Jenkins Open the ORCID record for Colin Jenkins [Opens in a new window] ,
Michael Levine ,
Stephen Sanko ,
Clayton Kazan ,
Caroline E. Thomas  and
Marc Eckstein
Colin Jenkins
Affiliation:
Keck School of Medicine, University of Southern California, Los Angeles, CaliforniaUSA
Michael Levine*
Affiliation:
Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CaliforniaUSA
Stephen Sanko
Affiliation:
Department of Emergency Medicine, University of Southern California, Los Angeles, CaliforniaUSA Los Angeles City Fire Department, Los Angeles, CaliforniaUSA
Clayton Kazan
Affiliation:
Los Angeles County Fire Department, Los Angeles, CaliforniaUSA
Caroline E. Thomas
Affiliation:
Southbank International School, Westminster, London, United Kingdom
Marc Eckstein
Affiliation:
Department of Emergency Medicine, University of Southern California, Los Angeles, CaliforniaUSA Los Angeles City Fire Department, Los Angeles, CaliforniaUSA
*
Correspondence: Michael Levine, MD Department of Emergency Medicine University of California, Los AngelesLos Angeles, CaliforniaUSA E-mail: michaellevine@mednet.ucla.edu
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Abstract

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.

Keywords

Emergency Medical Servicesnaloxoneopioidoverdoserespiratory depression
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 5 , October 2021 , pp. 543 - 546
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Coffa, D, Snyder, H. Opioid use disorder: medical treatment options. Am Fam Physician. 2019;100(7):416–425.Google ScholarPubMed
California Legislative Information. AB-2760 Prescription Drugs: Prescribers: Naloxone Hydrochloride and Other FDA-Approved Drugs. http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB2760. Accessed May 7, 2020.Google Scholar
Hoffman, JR, Schriger, DL, Luo, JS. Empiric use of naloxone in patients with altered mental status: a reappraisal. Ann Emerg Med. 1991;20(3):246–252.CrossRefGoogle ScholarPubMed
Friedman, MS, Manini, AF. Validation of criteria to guide prehospital naloxone administration for drug-related altered mental status. J Med Toxicol. 2016;12(3):270–275.CrossRefGoogle ScholarPubMed
Naloxone, Martin WR.. Ann Intern Med. 1976;85(6):765–268.Google Scholar
Buchwald, A. Naloxone use: side effects may occur. Ann Emerg Med. 1988;17(7):765.CrossRefGoogle ScholarPubMed
Lynn, RR, Galinkin, JL. Naloxone dosage for opioid reversal: current evidence and clinical implications. Ther Adv Drug Saf. 2018;9(1):63–88.CrossRefGoogle Scholar
Wermeling, DP. Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access. Ther Adv Drug Saf. 2015;6(1):20–31.CrossRefGoogle ScholarPubMed
Boyer, EW. Management of opioid analgesic overdose. N Engl J Med. 2012;367(2):146–155.CrossRefGoogle ScholarPubMed
Sanello, A, Gausche-Hill, M, Mulkerin, W, et al. Altered mental status: current evidence-based recommendations for prehospital care. West J Emerg Med. 2018;19(3):5247–5241.CrossRefGoogle ScholarPubMed