BACKGROUND: Northeast Tennessee has among the highest rates of opioid overdose deaths in the United States, driven primarily by the epidemic of prescription opioid abuse. Although Tennessee passed the Naloxone Rescue Act in 2014, we have found little evidence that naloxone is being prescribed or dispensed widely to persons at risk of opioid overdose in this region. We reviewed opioid overdose deaths in Northeast Tennessee during 2015 for potential missed opportunities for naloxone use by lay bystanders and emergency medical services (EMS).
METHODS: We performed a search for all 2015 deaths in the northeast health department region of Tennessee (7 rural counties) for which the cause of death was coded as drug overdose on the death certificate. We reviewed autopsy reports or medical records to determine manner of death, circumstances of death, presence of bystanders, and substances involved. Data were analyzed using EpiInfo 7.
RESULTS: We identified 80 drug overdose deaths during 2015; 58 (73%) deaths involved opioids. Among the 56 deaths with specific opioids identified on toxicology reports, 55 (98%) were associated with prescription opioid pain relievers and only 2 (4%) involved heroin; 97% were associated with multiple drug toxicities. Most deaths occurred in non-Hispanic whites (95%), males (69%), and persons aged 40-59 years (66%). Most deaths occurred in a home (90%) and with a bystander present (74%), although in only 12 (21%) cases did the bystander report witnessing the death event. However, among the 46 deaths that were not witnessed, 19 (41%) reportedly had possible warning signs (unusual snoring, slurred speech, agitation) for overdose. Among the 18 (31%) opioid overdose events to which EMS responded and performed cardiopulmonary resuscitation (CPR), naloxone was administered to 10 (56%) patients; naloxone was not administered by any bystanders.
CONCLUSIONS: Most overdose deaths (74%) in this study occurred with another adult (bystander) present in the same building, and most (53%) were either witnessed or exhibited warning signs for overdose before being found dead. These deaths represent potential missed opportunities for naloxone rescue or for earlier recognition of impending overdose by lay bystanders; increased naloxone education and distribution are recommended. Because national guidelines make no recommendations regarding administration of naloxone in opioid-associated cardiac arrest, it is difficult to determine whether any of these deaths represent missed opportunities for naloxone rescue by EMS. Considering the current epidemic of opioid overdose deaths, further evaluation of EMS protocols for administration of naloxone may be warranted.