- Allowing patients to decline transport after undergoing naloxone reversal of opioid overdose via emergency medical services (EMS) was associated with very low mortality in this systematic review.
- It remains unclear how long EMS should observe such patients before release.
Why this matters
- Field reversal of opioid overdose is increasingly common.
- Some patients decline further evaluation at the emergency department, leading to a “treat-and-release” scenario.
- The safety of this practice, as opposed to the more common “support and transport,” has been unclear.
- Deaths within 48 hours: 4/4912 (0.081%).
- 1 study reported on 1 adverse event (AE)—altered level of consciousness after release due to suspected rebound—and found zero instances.
- Evidence quality deemed “limited”; no publication bias detected.
- Systematic review of 7 studies assessing release after prehospital naloxone treatment in adults (n=4912).
- Outcome: 48-hour mortality due to rebound toxicity; AE at scene.
- Funding: None.
- 6 of 7 studies were retrospective.
- Low incidence of primary outcome prevented meta-analysis.
- In most, heroin was the opioid in question; results might not generalize to other opioids, such as methadone or fentanyl.