Examination of naloxone dosing patterns for opioid overdose by emergency medical services in Kentucky during increased fentanyl use from 2018 to 2021

Peter Rock, Svetla Slavova, Philip M. Westgate, Aisaku Nakamura, Sharon L. Walsh

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Fatal overdoses involving fentanyl/fentanyl analogs (F/FA) have increased in the US, raising questions about naloxone doses for F/FA overdose reversal. Emergency medical services (EMS) data provide an opportunity to examine naloxone administration changes as fentanyl increases in the illicit opioid supply. Methods: Administered naloxone intranasal-equivalent total dose (INTD) in milligrams (mg) was calculated for Kentucky EMS suspected opioid overdose (SOO) encounters (n=33,846), 2018–2021, and patterns of administration were examined. County-level F/FA availability was measured as 1) proportion of fatal drug overdoses involving F/FA, and 2) F/FA police seizures. Linear mixed models estimated changes in INTD in relation to local F/FA availability accounting for patient characteristics. Results: From 2018–2021, SOOs increased by 44% (6853 to 9888) with an average INTD increase from 4.5 mg to 4.7 mg, with more than 99% of encounters resulting in successful reversal each year. For SOO encounters examined by outcome at the scene (i.e., non-fatal fatal vs fatal), average INTD for non-fatal were 4.6 mg compared to 5.9 mg for fatal overdoses. Mixed modeling found no significant relationship between INTD and the two measures for local F/FA availability. Conclusion: As F/FA-involved overdose risk increased, we observed a modest increase in INTD administered in SOO EMS encounters – just slightly higher than the 4 mg standard dose. The lack of significant relationship between F/FA and naloxone dose suggests that naloxone utilization in SOO with EMS involvement remains effective for overdose reversal, and that EMS naloxone dosing patterns have not changed substantially.

Original languageEnglish
Article number111062
JournalDrug and Alcohol Dependence
Volume255
DOIs
StatePublished - Feb 1 2024

Bibliographical note

Publisher Copyright:
© 2023

Keywords

  • Emergency Medical Services
  • Fentanyl
  • Naloxone
  • Opioid Overdose

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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