Opioid-related incident severity and emergency medical service naloxone administration by sex in Massachusetts, 2013–2019

Abstract

Background: A Cross-sectional study of all emergency ambulance runs reported by licensed Emergency Medical Services (EMS) providers between 2013 and 2019 was undertaken to determine if the sex of a patient experiencing opioid-related symptoms had an impact on their odds of receiving naloxone from EMS. Methods: All runs within Massachusetts for individuals 11 years and older with a reported sex between 2013 and 2019 (n = 5,533,704 runs) were included. Covariates modeled were patient age, year of the incident, and county of the incident. Runs were separated into those that were opioid-related versus not; opioid-related runs were further subdivided into five severity categories including dead on arrival, acute opioid overdose, opioid intoxicated, opioid withdrawal, and other opioid-related incident. Results: Among opioid-related runs, women had 24% lower odds (95% CI 0.68–0.86) of appearing in the dead on arrival category and 20% lower odds (95% CI 0.78–0.82) of appearing in the acute opioid overdose category than men. Among acute opioid overdoses, runs where patient symptoms met Massachusetts EMS guidelines for naloxone administration, women had 18% lower odds (95% CI 0.76–0.89) of receiving naloxone than men. Conclusions: Sex-related differences persist in the odds of naloxone administration by EMS providers when controlling for symptom presentation.

Keywords:

• Naloxone
• opioids
• drug overdose
• Emergency Medical Services
• sex differences
• knowledge-mediated gender bias

Acknowledgements

The authors acknowledge Malena Hood and Jeffery Yu for their work on MA’s Opioid-Related Incident MATRIS definition, and Daniel Saxe and Dr. Jonathan Burstein for their help in reviewing and validating the Opioid-Related Incident MATRIS Severity Categories.

Disclosure statement

The authors have no conflicts of interest. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Massachusetts Department of Public Health, the Centers for Disease Control and Prevention, or the National Highway and Transportation Safety Authority.

Additional information

Funding

This work was supported by funds made available from the Centers for Disease Control and Prevention under Grant 1 [NB01OT009316-01-00] and the National Highway Traffic Safety Administration under Grant Section [405-c # 20.616].