Impact of Bystander Naloxone on Emergency Medical Transport Refusal After Opioid Overdose: A Statewide Retrospective Analysis.
Bystander-administered naloxone linked to nearly 3-fold higher odds of transport refusal.
Impact of Bystander Naloxone on Emergency Medical Transport Refusal After Opioid Overdose: A Statewide Retrospective Analysis.
The opioid epidemic remains a public health crisis in the United States.
To evaluate temporal trends, we performed separate logistic regression models with calendar quarter (Q) modeled as a continuous variable (Q1 2020-Q2 2024).
We performed a retrospective cohort study of suspected opioid overdoses reported to the Connecticut Statewide Opioid Reporting Directive (Statewide Opioid Reporting Directive) between November 1, 2019-June 30, 2024.
bystander-given naloxone nearly triples odds patients refuse transport
Among 15,025 nonfatal suspected overdoses involving naloxone in Connecticut, bystanders were initial administrators in 18%.
Transport refusal occurred more often after bystander administration compared to first responder administration (16.1% vs 6.2%).
During the study period, bystander administration increased from 15% in Q4 2019 to 24% in Q2 2024, corresponding to a 3.8% increase in odds per quarter (OR 1.04; 95% CI 1.03-1.05, P < .001).
Refusal more than doubled from 4% to 12%, with odds increasing 4.5% per quarter (OR 1.05; 1.04-1.06, P < .001).
Bystander-administered naloxone is increasingly common and strongly associated with higher odds of emergency medical services transport refusal.
While refusal does not always equate to unsafe outcomes, it represents missed opportunities for initiation of medications for opioid use disorder, harm reduction counseling, and linkage to care.
Emergency medical services agencies should consider strategies such as leave-behind naloxone, peer recovery coach deployment, and emergency medical services-initiated buprenorphine to capitalize on these encounters.