Naloxone administration and survival in overdoses involving opioids and stimulants: An analysis of law enforcement data from 63 Pennsylvania counties.

Background: In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.
Methods: The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018-July 2024. All measures, including suspected drug involvement, were based on first-responder assessment/report. Relative frequencies and chi-square tests were first used to compare suspected opioid overdoses with, versus without, stimulants (cocaine or methamphetamine) co-involved. Next, mediation analyses tested naloxone administration as a mediator in the association between stimulant co-involvement (in opioid overdoses) and survival.
Results: Naloxone was reportedly administered in 72.2 % of the suspected opioid-no-cocaine overdoses, compared to 55.1 % of the opioid-cocaine-involved overdoses, and 72.1 % of the opioid-no-methamphetamine overdoses vs. 52.4 % of the opioid-methamphetamine-involved overdoses. With respect to survival rates, 18.0 % of the suspected opioid-no-cocaine overdoses ended in death, compared to 41.3 % of the opioid-cocaine overdoses; 18.1 % of the opioid-no-methamphetamine overdoses ended in death, versus 42.9 % of the opioid-methamphetamine overdoses. In mediation analyses (adjusted for demographics, county, year, and other drug co-involvement), naloxone administration mediated 38.7 % (95 % Confidence Interval [CI], 31.3-46.0 %) of the association between suspected cocaine co-involvement and survival and 39.2 % (95 % CI, 31.3-47.1 %) of the association between suspected methamphetamine co-involvement and survival.
Conclusions: Among suspected opioid overdoses recorded in the Pennsylvania Overdose Information Network, stimulant co-involvement was associated with lower naloxone administration and higher fatality, with naloxone partially mediating the association between stimulant co-involvement and death.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Frank LoVecchio reports a relationship with AbbVie (antibiotics only) that includes: speaking and lecture fees. Abenaa Jones reports a relationship with National Institute on Drug Abuse that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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