RescueDigest Reads: NASEMSO Brief on the Use of Naloxone Out-Of-Hospital

The National Association of State EMS Officials (NASEMSO)  Issue Brief On the Use of Narcan In out of Hospital Settings


Is your department or are other emergency response or civilian groups in your area considering the distribution or use of Narcan by non-ALS personnel? If so, then this document is for you.


From the introduction:

“Deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States. Every day in the United States, 105 people die as a result of drug overdose, and another 6,748 are treated in emergency departments (ED) for the misuse or abuse of drugs. Nearly 9 out of 10 poisoning deaths are caused by drugs.” 

The National Association of State EMS Officials believes that the increase of substance abuse in the United States is a significant public health and public safety concern that warrants consideration of several related issues:

  • Acknowledgement of substance addiction as a serious health-threatening medical condition that requires intervention and treatment by medical professionals.
  • Opiate overdose can lead to respiratory failure, respiratory arrest, and imminent death if not properly and emergently managed by a medical professional.
  • Community efforts to control opiate overdose should include medical professionals, law enforcement, caregivers/family members, at-risk populations, and advocates working together to develop compassionate and collaborative strategies to reduce harm to victims of drug overdose.”



While the technical breakdown of some aspects of  opiate overdose and naloxone administration may be intimidating if you aren’t already familiar with them,  the bullet points in this document will allow you to speak the same language as the medical directors, private physicians, and others with whom you may need to speak about this topic.

Topics include:

1) Background

The narcotic overdose problem in the United States  and a listing of what medications fall into the category of opiates or narcotics.


2) Legislative Actions

An overview of the nineteen states ( and District of Columbia) that have, as of mid-2014, and acted some form of “Drug Overdose Community Good Samaritan Law.”

“States with 9-1-1 criminal immunity laws include: California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, Rhode Island, Utah, Vermont, Washington and Wisconsin.

States with immunity laws related to prescribing and administrating medication to reverse the effects of suspected opioid overdose: California, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, Utah, Vermont, Virginia, Washington and Wisconsin. “


3) Medical Issues

NASEMSO’s Position that there must be training and education for people who will be administering naloxone.

  • Many life-threatening conditions other than opiate overdose can cause altered mental
    status include trauma, stroke, sepsis, shock, dehydration, metabolic (chemical) imbalances, and low blood sugar. Each of these time-sensitive conditions require immediate intervention by licensed medical personnel and can be overlooked in patients with drug overdose if both conditions occur at the same time. Delayed appropriate medical diagnosis and intervention can result in permanent disability and even death.
  • The administration of naloxone causes the release of catecholamines that may precipitate acute narcotic withdrawal or unmask severe pain in those who regularly take opioids.
  • Side effects to the administration of naloxone to a person using opiates can be potentially life- threatening if individuals are not properly trained to recognize and respond to them. These can include–
  • Chest pain, tachycardia, irregular heartbeat that can precipitate myocardial ischemia
  • o Chest pain, tachycardia, irregular heartbeat that can precipitate myocardial ischemia
  • o Hypertension
  • o Cough, wheezing, feeling short of breath
  • o Pulmonary edema
  • o Severe nausea or vomiting than can result in aspiration; o Severe headache, agitation, anxiety, confusion;
  • o Seizures
  • Acute withdrawal can precipitate confusion and agitation, especially in patients that have combined the use of opioids with other substances. This could lead to violent confrontations with anyone that administers naloxone, including law enforcement.
  • Opioid addiction is associated with a multitude of associated medical and psychological problems including acute and chronic diseases, life-threatening infections, the risk for infectious disease, and severe and refractory pain that deserve proper evaluation and ongoing management by specially trained medical professionals.
  • In one study, the serum half-life of naloxone in adults ranged from 30 to 81 minutes (mean 64 ± 12 minutes). This half-life is shorter than the half-life of many opiates. When the dose of naloxone wears off, the victim can relapse into a life-threatening situation that is even more difficult to manage.
  • Given the shorter serum half-life of naloxone compared to most opiates, the patient must be closely monitored to determine need for repeated doses. 


4)  Policy Issues and Recommendations

  1. Require mandatory education and training in the prevention, detection, and appropriate response to drug overdose including:
    o activating the EMS system (“call 9-1-1”) prior to administering medications
    o recognition of opioid overdose symptomso proper technique for administration of the opioid antagonist o positioning of the victim
    o first aid for respiratory failure and acute opioid withdrawal o performance of cardiopulmonary resuscitationo essential follow-up procedures
  2. Require medical (physician) oversight over all community opioid antagonist programs to help maintain quality standards including proper packaging and labeling, training, and follow-up.
  3. Support drug misuse/abuse prevention efforts, access to treatment, and recovery support services.
  4. Require medical (physician) supervision of individuals that dispense opioid antagonists for the treatment of drug overdose.
  5. Require the agency dispensing the opioid antagonist to maintain records on the source, labeling, packaging, use and effects of opioid antagonist administration.
  6. Provide resources for medical examiners to submit a report to the state on every death in which a drug is detected in a decedent, including information on the manner of death (unintentional, suicide, homicide, or undetermined) and which drug(s) were detected in the decedent (including prescription drugs, illicit drugs, and alcohol). For each drug detected, the medical examiner should determine whether it played a causal role in the death or was merely present.
  7. Increased demand for access to naloxone and other opioid antagonists can create unexpected drug shortages, thus pharmacists and wholesale distributors should be required to prioritize naloxone and other opioid antagonist supplies to MEDICAL personnel such as EMS, emergency departments, and hospitals. 


5) References

Backing up what they say and why they say it. Keep these handy for discussions with internal and external stakeholders.



While there is a great deal of opinion and discussion currently available on this topic, this document gives a technical, but relatively concise outline for discussing this subject with the stakeholders in your area as well as a general work plan for what to do in your agency.


” Opioids — also called opiates or narcotics — are medications made from opium “

Like I say, they really break it down for you.

RescueDigest Reads finds the top reading picks for your emergency services library.


About romduck

Rom Duckworth is a dedicated emergency responder, author, and educator with more than thirty years of experience working in career and volunteer fire departments, hospital healthcare systems, and private emergency medical services. Rom is a career fire captain and paramedic EMS Coordinator for the Ridgefield (CT) Fire Department and director of the New England Center for Rescue and Emergency Medicine. Rom holds a master’s degree in public administration, is a graduate of the National Fire Academy’s Executive Fire Officer program, and is the recipient of the NAEMT Presidential Award, American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award. Rom is the author of "Duckworth on Education," as well as chapters in more than a dozen EMS, fire, rescue, and medical textbooks and over 100 published articles in fire and EMS magazines. A member of the NAEMT Board of Directors, as well as other national and international advocacy and advisory boards, Rom continues to work for the advancement of emergency services professions. Contact Rom via