Layperson Naloxone Administration and Subsequent Emergency Medical Services Care for Opioid Overdose

Background Layperson-administered naloxone is increasingly common before emergency medical services (EMS) arrival. However, EMS care following naloxone administered by laypeople rather than trained responders remains poorly characterized. Methods This cross-sectional study used the 2023 National EMS Information System dataset and included 9-1-1 activations for individuals aged ≥16 years with an EMS impression of opioid overdose and documented naloxone administration before EMS arrival. Exposures were layperson-administered naloxone (LAN) or trained responder-administered naloxone (TRAN; e.g., police, firefighter). The primary outcome was subsequent EMS naloxone administration. Secondary outcomes included total number of EMS naloxone administrations, advanced airway intervention, cardiac arrest, and EMS transport. We used descriptive statistics, t-tests, and multivariable logistic regression estimating adjusted odds ratios (aOR). Results Among 26,087 EMS activations, 8,016 (30.7%) received LAN and 18,071 (69.3%) TRAN. Any subsequent EMS naloxone administration was less frequent following LAN (24.4% vs. 34.8%; P <.001); when EMS did administer additional naloxone, the mean number of administrations was slightly higher following LAN (mean difference 0.05, 95%CI 0.02 to 0.09; P =.001). Advanced airway attempts (1.6% vs. 1.4%, P =.160) and cardiac arrest (6.6% vs. 6.0%, P =.080) were uncommon. EMS transport occurred less often after LAN (79.4% vs. 84.4%, P <.001). In adjusted analyses, LAN was associated with lower odds of subsequent EMS naloxone administration (aOR 0.73; 95%CI 0.68-0.78) and EMS transport (aOR 0.78; 95%CI 0.73-0.84). Conclusions Layperson-administered naloxone was associated with less frequent EMS naloxone administration and lower rates of EMS transport. These findings support layperson overdose response while highlighting the need to better understand post-overdose care trajectories.