Expansion of Emergency Medical Services' Naloxone Leave-behind Program in Philadelphia, Pennsylvania

Most decedents reviewed in Philadelphia, Pennsylvania’s overdose fatality review (OFR), OD Stat, had at least one interaction with emergency medical services (EMS) prior to their deaths. Philadelphia EMS has a naloxone leave-behind program, but the review team noted that many of the decedents would not have qualified for leave-behind naloxone and the accompanying education because they were not always using opioids. Much of the drug supply in Philadelphia is contaminated or adulterated with fentanyl, meaning that people who do not purposefully or knowingly use opioids could still be at risk for a future overdose. OD Stat pulled together a small subcommittee of public health and EMS staff members to review EMS’ current naloxone leave-behind policy. The policy at the time was to provide naloxone to people following a nonfatal opioid overdose. The Philadelphia OFR provided qualitative data from OD Stat showing that opioid overdose decedents often had EMS contacts prior to their overdoses for stimulant or hallucinogen-related calls. The OD Stat team recommended that the Philadelphia Fire Department/EMS update its policy to provide naloxone to any individual who uses drugs regardless of whether they knowingly use opioids or have experienced an overdose. By expanding its reach, EMS could provide education about widespread fentanyl contamination and increase its distribution of naloxone. EMS updated its internal policy and circulated an all-staff memorandum as of October 2020. Leave-behind naloxone was paid for through a grant funded by the Commonwealth of Pennsylvania. OD Stat tracks the number of leave-behind naloxone kits provided by EMS on an annual basis.