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The Gap Between Overdose Deaths and Narcan Use in Rural America

More rural EMTs need to be able to give out the overdose-reversing medicine when they go out on calls.
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The chemical formula of naloxone. (Photo: Zerbor/Shutterstock)

The chemical formula of naloxone. (Photo: Zerbor/Shutterstock)

The overdose-reversing medicine naloxone—trade-named Narcan—has garnered increasing support over the past few years. It's a life-saving medicine with only rare ill side effects. Some cities have even adopted programs that allow friends and family members of individuals addicted to heroin or opioid painkillers to keep doses of naloxone at home, for emergencies. Yet a new study finds that EMTs who respond to 9-1-1 calls about overdoses often don't give out the medicine, especially in rural regions of the United States.

In rural America, there's a particularly large gap between the rates at which people die of overdoses and how often EMTs give out naloxone, according to the study. In contrast, there are more deaths from opioid overdoses in suburban areas, but EMTs in the suburbs are also the most likely to turn to naloxone. (Urban areas are in the middle for both opioid overdose death rates and EMT naloxone use.) The numbers point to the need to get more rural EMTs to use the opioid-reversing medicine, the study's authors wrote in a paper, published last week in the American Journal of Public Health.

The authors, a team from various U.S. medical centers and the Centers for Disease Control and Prevention, analyzed data from the National Emergency Medical Services Information System. The system is a database that emergency rooms contribute to voluntarily; in it, the authors found data on more than 260,000 9-1-1 calls where the dispatcher sent EMTs to help with a suspected overdose. Their research suggests a few ways to up EMTs' naloxone use in rural America.


In the database, EMTs certified at a basic level were the least likely to give out naloxone. That makes sense because many states forbid basic EMTs from giving people anything but their own prescribed medicines and aspirin. Yet older studies have found that rural EMTs are the least likely to have an intermediate or higher certification. Part of the problem is that the higher level of training is costlier and rural hospitals tend to have smaller budgets.


Another reason basic EMTs don't often give out naloxone is because most states forbid them from giving shots. Such rules are in line with national guidelines about EMT training.

Naloxone comes as a shot, an intravenous-line solution, and a nasal spray. Giving the latter to rural emergency departments, many of which rely on basic EMTs, could help.


Among those states that would forbid a basic EMT from giving out even nasal-spray naloxone doses, a change in rules would help. If families of all backgrounds can give the drug safely to their loved ones, so can a trained EMT.

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