Prepare Your Community

Duration: March 26, 2022–August 16, 2023

Sample: 354 Doses of Intranasal Naloxone distributed by New York State Police.

Methods:

• Beginning in March 2022, 11 NYS police troops were engaged to field test 8-mg vs 4-mg IN naloxone. The 8-mg naloxone spray was used by 3 troops; the remaining 8 troops used 4-mg naloxone spray.

• Participating NYS police received standardized training on responding to possible overdose events, as well as CPR training.

• Naloxone administration reports were reviewed at regular team meetings, including by two physicians, and body camera footage was reviewed by study authors when indicated.

Results:

• Overall, survival was 99.0% with 8-mg naloxone and 99.2% with 4mg naloxone.
• The average number of doses administered did not differ by formulation. Mean number of doses: 1.58 doses for 8mg group, 1.67 doses for 4mg group.
• Opioid withdrawal signs or symptoms were significantly more likely with 8mg naloxone recipients than 4mg recipients (relative risk = 2.51).

Postnaloxone Signs and Symptoms:

• The most common postnaloxone signs and symptoms experienced among both groups were disorientation and lethargy, but did not differ significantly by formulation.

• Persons who received the 8mg naloxone were 2.5-times (RR*) as likely to experience post-naloxone opioid withdrawal signs and symptoms, including vomiting, compared with those who received 4mg.

Author's Limitations:

1. Responding law enforcement personnel are not medical providers, and inconsistencies in their classification of postnaloxone symptoms or behaviors might have occurred. However, NYSP personnel have been reporting using a similar form for several years and are experienced in assessing symptoms and behaviors.

2. The number of 8mg intranasal naloxone administration reports included was limited because only three of 11 NYSP troops received this formulation. With an increased sample size, additional differences in outcomes between groups might have been observed.

3. No information could be compared about differences between groups on the type or dose of substance used before suspected overdose, vital signs, or demographics.

4. Because the data were gathered from New York State only, the opioid potency might not reflect that in other areas.

*Relative Risk: likelihood or probability of an event occurring in one study group versus another study group.