Ager Emily E, Purington Ella K, Purdy Megan H, Benenati Brian, Baker Jessica E, Schellack Christine Jane, Smith Graham C, Hunt Nathaniel R, Losman Eve D
Department of Emergency Medicine University of California, San Francisco San Francisco California USA.
Department of Emergency Medicine Denver Health Denver Colorado USA.
J Am Coll Emerg Physicians Open. 2024 Oct 15;5(5):e13300. doi: 10.1002/emp2.13300. eCollection 2024 Oct.
We evaluated a novel leave-behind naloxone (LBN) program that allows Emergency Medical Services (EMS) personnel to distribute naloxone after an opioid overdose. Our objective was to explore EMS engagement and experiences with the program, as well as interest in education on addiction and harm reduction. We also assessed the acceptability of LBN programs among people who use drugs (PWUD).
We conducted telephone interviews with EMS personnel and residents of substance use recovery housing between February and September 2023. EMS personnel described their direct experiences with the LBN program and perceived facilitating factors and barriers to naloxone distribution. First responder interactions and support for LBN were explored with PWUD. A rapid assessment method was used to analyze the interview data.
Eighteen of the 23 EMS participants had distributed LBN; most agreed EMS agencies should have an LBN program. Barriers included forgetting, patient acuity, patients declining, and perceived liability. Facilitators included having a clear protocol, accessible kits, and minimal documentation burden. The majority expressed interest in harm reduction education. Eight of the 11 PWUD participants reported recent involvement in an opioid overdose. The majority supported LBN and felt comfortable receiving naloxone training from EMS.
In this qualitative evaluation, we found broad support for EMS-based naloxone distribution among EMS personnel and PWUD. We identified several modifiable barriers to the success of such programs, which should be the subject of future investigation. EMS and harm reduction communities should support the expansion of LBN programs across the United States.
我们评估了一种新型的遗留纳洛酮（LBN）项目，该项目允许紧急医疗服务（EMS）人员在阿片类药物过量使用后分发纳洛酮。我们的目标是探讨EMS人员对该项目的参与情况和体验，以及他们对成瘾和减少伤害教育的兴趣。我们还评估了吸毒者（PWUD）对LBN项目的接受程度。
我们在2023年2月至9月期间对EMS人员和物质使用康复住房的居民进行了电话访谈。EMS人员描述了他们在LBN项目中的直接经历，以及纳洛酮分发过程中感知到的促进因素和障碍。与PWUD探讨了急救人员与LBN的互动及支持情况。采用快速评估方法分析访谈数据。
23名EMS参与者中有18人分发过LBN；大多数人认为EMS机构应该有一个LBN项目。障碍包括遗忘、患者病情严重程度、患者拒绝以及感知到的责任。促进因素包括有明确的方案、可获取的试剂盒以及最小的文件负担。大多数人表示对减少伤害教育感兴趣。11名PWUD参与者中有8人报告近期参与过阿片类药物过量事件。大多数人支持LBN，并对接受EMS的纳洛酮培训感到安心。
在这项定性评估中，我们发现EMS人员和PWUD对基于EMS的纳洛酮分发普遍支持。我们确定了此类项目成功的几个可改变的障碍，这应是未来调查的主题。EMS和减少伤害社区应支持在美国扩大LBN项目。
