A recent study from the American Journal of Public Health takes a look at emergency medical service providers’ administration of naloxone, a drug used to treat respiratory suppression in cases of opioid or heroin overdoses.   As revealed in the study, while these overdoses pose a major threat to our nation’s public health, the administration of naloxone is dependent upon emergency personnel certification level, potentially posing a risk in certain U.S. communities over others.

Public Health Newswire spoke with the study’s lead researcher, Mark Faul, PhD, of the Centers for Disease Control and Prevention, to learn more about the study’s findings on naloxone administration, disparities that exist in U.S. drug overdoses and recommendations to prevent future cases.

You describe naloxone as “the drug most commonly administered to adolescents in the prehospital setting,” in the case of a drug overdoses, but the drug has been met with controversy. Tell us more about the use of naloxone and what makes it a hot-button topic.
The literature review revealed that another study by Seidel, 1991, found that naloxone was the most commonly administered medication among adolescents. The current study findings (Faul, et. al., 2015) show that 20-29 year olds were most likely to receive an administration of naloxone by emergency medical service providers – or EMS – when there was a suspected drug overdose. Naloxone administration is an important tool in the efforts to save lives amid an epidemic of opioid and heroin overdose deaths. In recent years, naloxone has been distributed to family members and police officers to reverse drug overdose. It is also co-prescribed with opioids in some situations. Yet, many basic EMS providers are not authorized to administer the drug to help reduce opioid and heroin overdose deaths.

Opioid overdose mortality is a major—and preventable—threat to public health. How serious and commonplace are drug overdoses in the U.S. today and how has this changed over time?
In 2013, more than 16,000 people in the U.S. died from drug overdoses involving prescription opioids. In addition, about two million Americans abused prescription opioids. Sales of these drugs nearly quadrupled from 1999 to 2013, and overdose deaths quadrupled in lockstep. Health care providers wrote 259 million prescriptions for opioids in 2012 – enough for every American to have a bottle of pills. However, there hasn’t been an overall change in the amount of pain Americans report.

Although prescription opioid overdose deaths are still a serious public health epidemic, 2012 saw the first national decrease in prescription opioid overdose deaths since the 1990s. This decrease paralleled a drop in prescribing. Improving prescribing practices through prescription drug monitoring programs can be a valuable strategy in reducing prescription opioid overdose deaths, in addition to expanding naloxone use among emergency medical professionals.

Your paper is included in an American Journal of Public Health supplement themed, “The Science of Eliminating Disparities.” Who is most burdened by disparities in drug overdose cases and what might be contributing to these disparities?

This study examined the overdose burden and the use of naloxone in rural areas. While the drug overdose burden was 45% higher in rural areas compared to urban areas, the use of naloxone by EMS providers in rural areas was only 22.5% higher compared to urban EMS naloxone use. Therefore, the use of naloxone in rural areas was much lower than expected.

The paper also points out that fewer advanced EMS providers are in rural areas, and the emergency medical system may therefore rely more heavily on basic EMS providers. However, many U.S. states have adopted national guidelines that prohibit basic EMS providers from administering naloxone, contributing to disparities in rural areas.

What are your recommendations to help reduce disparities in drug overdose prevention?

The current study indicates that the following can help reduce opioid overdose disparities:

  1. Providing additional training to EMS so that they can obtain the proper certification to administer pharmaceuticals such as naloxone.
  2. Changing the scope of practice to allow EMT-basics to administer intranasal or intramuscular naloxone. This change may save lives and reduce the burden of complications from opioid or heroin overdose, particularly in the rural environment.
  3. Improving EMS surveillance systems and ensuring their full integration into the health care system. Such data can also lead to better determination of the true incidence of opioid overdoses reversed by out-of-hospital naloxone administration. Such improvements may lead to rehabilitative services for and treatment of those addicted to opioids and heroin.
  4. Developing universal and national guidance on naloxone administration.

CDC remains committed to preventing prescription drug overdose deaths by improving data quality and surveillance, strengthening state efforts by scaling up effective public health interventions and equipping health care providers with the data and tools needed to improve the safety of their patients. More information can be found on the prescription drug overdose epidemic and promising strategies on the CDC’s website.

For more about the study and other new public health research, visit the American Journal of Public Health.