In cases where 911 is called, more bystanders than previously have been using naloxone when they believe someone is experiencing an opioid-involved overdose, according to new research. But this still occurs only in a small minority of such cases.
United States overdose deaths fell slightly overall in 2023, but continue at once-unheard of rates; many communities have experienced no decline. Efforts to stem the crisis have significantly focused on improving access to naloxone, the medication that reverses an opioid overdose. Two naloxone products have been made available over-the-counter at pharmacies, though cost is a barrier, so the impact is likely to be limited.
The likelihood that more people than before now have naloxone in their homes and workplaces is crucial, when past research has found that in close to 40 percent of fatal overdose cases, at least one other person was present at the scene.
The new study was published in the Journal of the American Medical Association (JAMA). The researchers looked at data from over 65 million emergency medical incidents in the US, from June 2020-June 2022. They used the National Emergency Medical Services Information System (NEMSIS), a national emergency care database, to examine how often laypeople—as opposed to medical staff or first responders—administered naloxone.
“This period had a significant increase in [layperson naloxone] usage.”
The authors found a change in naloxone usage during the COVID-19 pandemic, a time when overdose deaths surged amid huge disruptions to health care and harm reduction services.
“This period had a significant increase in [layperson naloxone] usage,” they wrote, “underscoring its evolving role in public health strategies aimed at effectively addressing the opioid crisis. These lifesaving interventions, facilitated by legislative changes making naloxone more accessible, such as making naloxone available over the counter or through Good Samaritan laws, increasingly involved [bystanders] and reflected an important shift toward community involvement in overdose response.”
Over the two-year period studied, they found over 744,000 reports of patients receiving naloxone (of course, this doesn’t demonstrate that an opioid overdose was experienced in every case). In 3.4 percent of those incidents, it was administered by a layperson. The authors found that nationwide, emergency technicians recorded fewer cases of naloxone being given over the time period, with a 6.1 percent decrease—but more cases of laypeople administering naloxone, with an increase of 43.5 percent over the two years.
Patients receiving naloxone in this way were found to be primarily men (69 percent), and most frequently in the 25-34 age bracket (36.5 percent). The authors did not analyze for race or ethnicity due to inadequate data. Most cases of laypeople giving a person naloxone were in urban settings (87 percent) and in private homes (53 percent).
During the same two-year period, we know—based on CDC data—that nationwide opioid-involved overdose deaths increased by 15.2 percent. More laypeople administering naloxone would be a welcome response to that growing crisis.
“This gap underscores the imperative to not only improve naloxone education and access but also to investigate other obstacles to its utilization.”
But the findings also reflect a troubling reality: When all cases included in the data started with a 911 call, that means someone else was almost always present at the scene, potentially able to administer naloxone. Yet in almost 97 percent of cases, they didn’t—whether because they didn’t have naloxone, didn’t know how to use it, or for other reasons.
“This gap underscores the imperative to not only improve naloxone education and access but also to investigate other obstacles to its utilization in real-world contexts,” the study authors wrote.
The “other obstacles” include fear, when people who were with the victim, and may have been using or sharing drugs with them, fear being questioned, arrested and potentially prosecuted if the police arrive.
At least 48 states and Washington, DC, have “Good Samaritan” laws, which offer some legal protections if you call 911 in an overdose case. Yet as Kastalia Medrano has described for Filter, most of these laws offer wholly inadequate protections for the majority of people most likely to find themselves in such situations.
There’s much the recent research doesn’t tell us. What about overdose cases where a friend, family member or other bystander administers naloxone, but no one calls 911? It is likely that most naloxone use—including, very frequently, administration by people who use drugs—falls into this category.
Important demographic data are another big omission, when we know that Black and Indigenous communities, for example, have been disproportionately impacted by the devastating overdose crisis.
Nonetheless, the authors wrote, “our study provides a crucial first step in establishing national estimates for [layperson use], highlighting its importance.”
“The absence of a unified tracking system for naloxone administration outside formal medical settings inhibits our understanding of its usage patterns,” they added. “However, this underscores the need for future systems to enhance [such] monitoring.”
Photograph via government of Forsyth County, North Carolina