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Impact of Bystander Naloxone on Emergency Medical Transport Refusal After Opioid Overdose: A Statewide Retrospective Analysis.

Introduction: The opioid epidemic remains a public health crisis in the United States. Naloxone is a cornerstone of overdose reversal, and its increasing availability to bystanders has improved immediate survival. However, little is known about how bystander naloxone administration influences use of...

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Publicado en:Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Vol. 27; no. 3; pp. 589 - 597
Autores principales: Carnevale, Daniella M., Canning, Peter, Kostyun, Regina, Kamin, Richard
Formato: research tables/charts Journal Article
Publicado: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health May2026
Acceso en línea:Ver este registro en EBSCOhost
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      dt: May2026
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      pub: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
      place: Orange, California
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        10.5811/westjem.50754
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        atl: Impact of Bystander Naloxone on Emergency Medical Transport Refusal After Opioid Overdose: A Statewide Retrospective Analysis.
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        au:
          Carnevale, Daniella M.
          Canning, Peter
          Kostyun, Regina
          Kamin, Richard
        affil: University of Connecticut School of Medicine, Farmington, Connecticut.
      sug:
        subj:
          Emergency Care
          Naloxone Therapeutic Use
          Naloxone Administration and Dosage
          Opiate Overdose Drug Therapy
          Transportation of Patients
          Treatment Refusal
          Human
          Male
          Female
          Adult
          Middle Age
          Retrospective Design
          Record Review
          Connecticut
          Sociodemographic Factors
          Time Factors
          Bivariate Statistics
          Multivariate Analysis
          Multiple Logistic Regression
          Odds Ratio
          Confidence Intervals
          Descriptive Statistics
          Age Factors
          Sex Factors
          Chi Square Test
          Mann-Whitney U Test
          Data Analysis Software
          Prospective Studies
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Male
          Female
      ab: Introduction: The opioid epidemic remains a public health crisis in the United States. Naloxone is a cornerstone of overdose reversal, and its increasing availability to bystanders has improved immediate survival. However, little is known about how bystander naloxone administration influences use of emergency medical services (EMS), particularly patient refusal of transport. Understanding these dynamics is critical for development of EMS protocol and harm reduction strategies. Methods: We performed a retrospective cohort study of suspected opioid overdoses reported to the Connecticut Statewide Opioid Reporting Directive (SWORD) between November 1, 2019– June 30, 2024. The primary outcome was EMS transport refusal, defined as non-transport after naloxone administration. The primary exposure was initial naloxone administrator (bystander vs first responder). Secondary variables included naloxone dose frequency, patient demographics, and time. Bivariate tests compared group differences. We used multivariable logistic regression to assess the association between bystander naloxone and refusal, adjusting for covariates. To evaluate temporal trends, we performed separate logistic regression models with calendar quarter (Q) modeled as a continuous variable (Q1 2020–Q2 2024). Results: 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%). In adjusted analyses, bystander administration was associated with nearly threefold higher odds of refusal (adjusted odds ratio [aOR] 2.90; 95% CI, 2.53-3.31). Multiple-dose incidents were associated with decreased refusal (aOR 0.83; 0.72-0.93). 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). Conclusion: Bystander-administered naloxone is increasingly common and strongly associated with higher odds of EMS 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 EMS-initiated buprenorphine to capitalize on these encounters.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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