Engaging Emergency Medical Services in Naloxone Distribution to Reduce Drug Overdoses

Increasing access to naloxone is an important strategy to reduce opioid overdose deaths. The Baltimore County Department of Health and the Baltimore County Fire Department Emergency Medical Services (EMS) have combined their efforts to distribute naloxone kits at the scene of an overdose through their "leave behind" program. This cross-sectional study aimed to investigate the distribution of naloxone leave-behind kits by EMS providers and identify factors associated with it. Participants included 127 active EMS providers who completed a self-reported online survey between August 2023 and January 2024 (career EMS = 73.2%, volunteer EMS = 26.8%). We used descriptive analysis to explore participant characteristics, naloxone distribution, reasons for not leaving a naloxone kit, attitudes toward harm reduction, and burnout. We conducted logistic regression analysis to identify factors associated with naloxone distribution. Almost half of the EMS participants (48.8%) reported leaving a naloxone kit on their most recent drug overdose response call. Among those who did not leave behind a naloxone kit, the most endorsed self-reported reasons included EMS providers not having the kit or enough time, and patients refusing to take the kit or already having it. Leaving behind a naloxone kit was significantly associated with positive attitudes toward harm reduction and being a career vs. volunteer EMS provider, after adjusting for other study variables. EMS is primarily designed to respond to emergencies. Enhanced training and support for EMS providers are needed to fully integrate harm reduction approaches to prevent drug overdoses.