Naloxone Access and Utilization for Suspected Opioid Overdoses
Revised June 2016
Originally approved October 2015
The American College of Emergency Physicians (ACEP), the
National Association of EMS Physicians (NAEMSP), and the American College of
Medical Toxicology (ACMT) affirm their commitment to emergency care for victims
of suspected opioid overdose and support the following:
Naloxone access and administration should be allowable but
not required for administration by public safety/health professionals,
including but not limited to law enforcement officers, firefighters, emergency
medical responders, emergency medical technicians, advanced emergency medical
technicians and paramedics. Public
safety/emergency medical services (EMS) agencies that contemplate the
utilization of naloxone are advised that:
and administration should be overseen by physician(s) knowledgeable about the
agency’s service area, patient care needs, and its public safety and health
capabilities. The physician most
appropriate for such oversight is the EMS medical director for the service
area. Medical toxicologists and/or a Poison Control Centers may add value to
the EMS physician as subject matter experts regarding opioid overdose patterns
and model treatment expertise.
may not be appropriate for all agencies. Specifically, in situations in which
timely and effective access to naloxone in the out of hospital setting is
already present, additional purchasing and provisioning of naloxone may well be
clinically unwarranted and fiscally unwise.
should not be deployed as the sole intervention for treatment of opioid
overdose by public safety/EMS agencies.
Instead, it should be deployed as part of a comprehensive opioid
toxicity protocol that encompasses management of the patient’s airway
artificial (eg. bag-valve-mask ventilation) regardless of whether naloxone is
safety/EMS personnel should complete an educational program regarding the signs
and symptoms of opioid overdose, utilization of EMS for victims of suspected
opioid overdoses, naloxone effects and side effects, and indications for
safety agencies considering administering naloxone should include training in
basic life support airway management and cardiopulmonary resuscitation as an
integral part of any naloxone administration program.
safety/EMS naloxone training should include an overview of pertinent state
laws. Laws should include liability protection for any public safety/emergency
medical services personnel administering naloxone without gross negligence and
with good intent.
administration by public safety/EMS personnel should be achieved in a
needleless manner whenever feasible and clinically appropriate to reduce the
potential for needle-stick injury and infectious disease exposure.
should be developed to track and report distribution and usage of naloxone both
by public safety/EMS personnel and bystander/public access individuals.
ACEP, NAEMSP, and ACMT further affirm that emergency
physicians may have an important role in promoting access to naloxone via
prescription whenever a patient’s risk profile suggests potential benefit for
the ready availability of naloxone in that patient’s anticipated future
out-of-hospital emergency health care needs.
Appropriate related indemnification should be extended to such
prescribing physicians and/or other prescribing healthcare professionals.
ACEP, NAEMSP, and ACMT additionally affirm their collective
belief that pharmacists should be allowed, but not required, to dispense
naloxone over the counter, and laypersons should be allowed to administer this
medication for cases of suspected opioid overdose. As with prescribing healthcare professionals,
appropriate related indemnification should be extended to involved laypersons
and pharmacists. If a pharmacist chooses
to distribute/dispense naloxone, the following information should be provided
to the direct recipient(s):
education regarding the signs and symptoms of opioid overdose, the importance
of promptly accessing emergency medical services via 911, naloxone effects and
side effects, indications for naloxone administration, and at minimum, chest
compressions for suspected cardiopulmonary arrest.