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224 The effect of housing status (homelessness vs. housed) on naloxone administration among patients with opioid overdose assessed by emergency medical services: A prehospital cross-sectional review

Published online by Cambridge University Press:  24 April 2023

Tiffany M. Abramson
Affiliation:
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Divisions of Emergency Medical Services and Research
Corey M. Abramson
Affiliation:
University of Arizona, Department of Sociology
Stephen Sanko
Affiliation:
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Divisions of Emergency Medical Services and Research
Marc Eckstein
Affiliation:
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Divisions of Emergency Medical Services and Research
Suzanne Wenzel
Affiliation:
Suzanne Dworak-Peck School of Social Work, University of Southern California
Elizabeth Burner
Affiliation:
Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, Divisions of Emergency Medical Services and Research
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Abstract

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OBJECTIVES/GOALS: People experiencing homelessness vs. housed peers have higher rates of substance use disorders as well as increased emergency medical services (EMS) use. However, it is unknown if EMS administers naloxone at different rates to people experiencing homelessness. We address if patient housing status impacts naloxone administration by EMS providers. METHODS/STUDY POPULATION: We conducted a retrospective, cross-sectional analysis of electronic patient care reports (ePCRs) for all 911-incidents attended by the Los Angeles Fire Department (LAFD) during the study period, January to December 2018. Individuals who were medically assessed by the LAFD and who were administered naloxone by LAFD EMS were included. Exclusion criteria was incomplete ePCRs. The primary outcome was prevalence of EMS naloxone administration by housing status in the city of Los Angeles. We used descriptive statistics and a logistic regression model to examine differences in care. RESULTS/ANTICIPATED RESULTS: Naloxone was administered in 2,438 of the 345,190 incidents that occurred during the study period. 608 (25%) incidents involved people experiencing homelessness. Top indications for naloxone administration were similar in both groups: overdose, altered consciousness and cardiac arrest. Of those who received naloxone, people experiencing homelessness were more likely to be male (82% v 67%) and younger (41 v 46 years). People experiencing homelessness were more likely to receive naloxone (OR 2.6, 95% CI 2.4-2.9). People experiencing homelessness received naloxone at a rate of 44 times that of housed peers. A logistic regression model adjusting for gender, age, respiratory depression and transport status showed people experiencing homelessness remained more likely to receive naloxone (OR 2.3, 95% CI 2.0-2.5). DISCUSSION/SIGNIFICANCE: Emergency medical services are more likely to administer naloxone to people experiencing homelessness than housed peers. There is a need to identify bias and factors that impact prehospital care and patient outcomes of people experiencing homelessness. New care pathways for people confronting homelessness and opioid use disorders are needed.

Type
Health Equity and Community Engagement
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
© The Author(s), 2023. The Association for Clinical and Translational Science