The analytic framework depicts the relationship between the population, intervention, outcomes and harms of naloxone administration by emergency medical services personnel. The far left of the framework describes the target population for treatment as adults with confirmed or suspected opioid overdose. To the right of the population is an arrow representing the administration of naloxone. The administration of naloxone arrow has four arrows coming out of it. The first represents the harms of administration including rates/severity of drug withdrawal, combativeness and injury to naloxone administrator. The second leads directly to the health and healthcare utilization outcomes. Health outcomes include: mortality, time to reversal of symtoms, respiratory or cardiac arrest, function, quality of life, other clinical sequelae of opioid overdose, rates of linkage to treatment for opioid use disorder, and rates of subsequent opioid overdoses. Healthcare utilization outcomes include hospital admission and cost to the emergency medical services agency for providing treatment. The two additional routes from the naloxone administration arrow to the health and healthcare utilization outcomes symbolize the transfer to hospital or no transfer to hospital.

Figure 1Analytic framework

*

Patients with confirmed or suspected opioid overdose who exhibit altered mental status, miosis, or respiratory distress and who are treated in the out-of-hospital setting by emergency medical services personnel

†

Administration of naloxone hydrochloride via the nasal, intravenous, intramuscular, or subcutaneous injection (including the naloxone auto-injector)

‡

Key Question 1 addresses comparisons involving route of administration and dose; Key Question 2 addresses comparisons involving dose titration to varying degrees of return of consciousness (intermediate outcome)

From: Introduction

Cover of Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel
Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel [Internet].
Comparative Effectiveness Reviews, No. 193.
Chou R, Korthuis PT, McCarty D, et al.
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