Use of Multiple Naloxone Administrations in the Emergency Department: A Retrospective Claims-Based Analysis

Potent synthetic opioids such as fentanyl and its analogues now account for most opioid overdose deaths in the United Stated (US). To help combat this development, Food and Drug Administration (FDA)-approved doses of the opioid overdose reversal agent naloxone and use of multiple naloxone administrations by emergency medical services (EMS) have increased.

To determine whether use of multiple naloxone administrations was similarly increasing in emergency departments (EDs) by investigating recent trends in ED naloxone use.

A retrospective claims-based cohort study using data from the Merative MarketScan® and the National Emergency Department Sample (NEDS) databases was conducted. The percentage of patients who received multiple naloxone administrations during their first ED visit in the analysis period (MarketScan) and percentage of ED visits with multiple naloxone administrations (NEDS) were calculated with 95% confidence intervals. Time trends were analyzed by 2-sided Cochran-Armitage trend tests.

Among MarketScan patients who received naloxone in the ED, the percentage who received multiple naloxone administrations was 14.7% across the years 2016 to 2022 and increased 72.8% from 10.1% to 17.4%. (p < 0.01). Similarly, the percentage of NEDS ED visits with multiple naloxone administrations among visits where naloxone was administered was 6.3% in 2016 to 2021 and increased 146.7% from 3.0% to 7.3% (p < 0.01).

A small but growing percentage of ED patients require multiple naloxone administrations, highlighting the need to monitor this trend and the ongoing adequacy of current treatment options for managing opioid intoxication.