Across the nation states are passing initiatives to allow EMS services to leave naloxone kits on scene with at risk patients, their family, friends or bystanders.
In Connecticut, kits may be left with a patient who refuses treatment/transport, a patient family member or friend when a patient is transported, as replacement for bystander/layperson who provided naloxone prior to EMS arrival, or for an individual requesting naloxone at EMS station or on scene.
Each kit contains two 4 mg Naloxone intranasal devices, and instruction card for use, a CPR face shield, and instructions on how to access services.
I have given out kits on multiple occasions.
A recent paper published in JAMA Open Network states overdose deaths can be reduced by 37% by combining naloxone distribution with efforts to get people to stop using alone. I have been on many scenes where I found a patient long dead with unopened naloxone within a few feet of their bodies. Naloxone by itself isn’t worth much if there is no one to administer it when a patient overdoses.
Never use alone and always have naloxone handy is a message EMS is in perfect position to give as we deal often with at-risk patients in the very setting where they are most likely to overdose.
That said, Naloxone Leave Behind programs do not always live up to expectations.
A recent study in Vermont found kits were only distributed to 50% of at-risk patients who refused transport to the hospital. At risk patients were defined as patients with confirmed opioid use, concern expressed by family or others on the scene that the patient was using substances, presence of drug paraphernalia, and/or clinical signs and symptoms of opioid use.
I think 50% is not bad. I would estimate the leave rate is much lower in Connecticut.
A recent article in JEMS, Exploring Barriers to Implementing an Emergency Medical Services Naloxone Leave Behind Program, found that only 13.3% of EMS survey respondents in Tennessee felt EMS should leave naloxone with patients or their families. Many believed passing out kits would actually accelerate drug abuse. (11.4% disagreed with the statement “Increasing access to naloxone will result in increased opioid use.”
In Maine where kits were only being left behind 20% of the time, a law was passed in 2023 requiring the kits to be passed out. Only 50% of the state’s providers had completed the mandatory training just days before the deadline.
Clearly, we in EMS have to do a better job of training our people to understand the history of the opioid epidemic, the science of addiction, the dangers of stigma and the benefits of harm reduction, including EMS Naloxone Leave behind.
Here’s a great EMS friendly video that makes the case for post-overdose intervention such as naloxone leave behind: