Written by Jason Lesnick
This retrospective analysis found an increased rate of repeat naloxone administration in US EDs from 2016–2022.
Needing naloxone to navigate new novel narcotics…
This retrospective claims-based cohort study analyzed naloxone use in U.S. EDs and looked for changes in the rate of multiple naloxone administrations over time.
Using a retrospective, claims-based cohort design with MarketScan (2016–2022) and NEDS (2016–2021) databases, investigators analyzed over 2.3 million ED visits looking at the percentage of patients who received multiple doses of naloxone during their ED visit and the percentage of ED visits with multiple naloxone administrations.
They found that among naloxone-treated ED patients, multiple administrations increased from 10.1% to 17.4% in MarketScan (72.8% relative increase) and from 3.0% to 7.3% of visits in NEDS (146.7% increase), respectively (p < 0.01).
When counting all ED visits in this sample, 11.8% of patients received 2 naloxone doses, and 3.7% received 3 or more administrations. This analysis found that the adjusted odds of receiving multiple administrations of naloxone increased by 10–13% per year.
The authors note a few significant limitations with their data—they were unable to determine how naloxone infusions were classified and unable to determine what percent of patients in each database received naloxone by EMS.
How will this change my practice?
This study reinforces my practice of having a low threshold to give additional naloxone in patients currently experiencing opiate overdose who have not had an adequate response. This study also suggests to me that prolonged observation periods (i.e. 6 hours) after a patient has required naloxone for opiate reversal should be considered if one suspects synthetic opiates as the cause—especially in cases where patients required multiple administrations.
Editor’s note: The rise of new, super-potent synthetic opioids—nitazenes—may be driving renarcotization. Watch patients with opioid overdose at least 6 hours if you can. ~Clay Smith
Source
Use of Multiple Naloxone Administrations in the Emergency Department: A Retrospective Claims-Based Analysis. J Emerg Med. 2025 Dec;79:111-122. doi: 10.1016/j.jemermed.2025.04.022. Epub 2025 May 8. PMID: 41129837.
