Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?

FRANÇAIS :
Dans le système des urgences préhospitalières de San Diego, la naloxone est autorisée et très souvent utilisée en cas de suspision d'overdose à l'héroïne par le personnel paramédical. Les patients peuvent également ne pas être hospitalisés sur leur simple demande et sans avis médical si ce premier traitement a été efficace. L'étude tente de vérifier si cette pratique peut être source d'overdose ultérieure. Rétrospectivement, tous les dossiers des patients décédés de mort non naturelle au cours de l'année 1996 ont été étudiés. Les dossiers des cas liés à un usage d'opiacés ont été comparés à ceux de patients qui avaient reçus de la naloxone sans avoir été hospitalisés. Il y avait 117 cas de morts par overdose aux opiacés et 317 cas de patients qui avaient reçu de la naloxone et refusé un traitement ultérieur. La comparaison des dossiers par âge, date, sexe, localisation et ethnie n'a pas mis en évidence de cas de patients traités en urgence par la naloxone qui soient décédés dans les 12h d'une overdose aux opiacés.
ENGLISH :
Objective. Naloxone is frequently used by prehospital care providers to treat suspected heroin and opioid overdoses. The authors' EMS system has operated a policy of allowing these patients, once successfully treated, to sign out against medical advice (AMA) in the field. This study was performed to evaluate the safety of this practice. Methods. The authors retrospectively reviewed all 1996 San Diego County Medical Examiner's (ME's) cases in which opioid overdoses contributed to the cause of death. The records of all patients who were found dead in public or private residences or died in emergency departments of reasons other than natural causes or progression of disease, are forwarded to the ME office. ME cases associated with opiate use as a cause of death were cross-compared with all patients who received naloxone by field paramedics and then refused transport. The charts were reviewed by dates, times, age, sex, location, and, when available, ethnicity. Results. There were 117 ME cases of opiate overdose deaths and 317 prehospital patients who received naloxone and refused further treatment. When compared by age, time, date, sex, location, and ethnicity, there was no case in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opiate overdose. Conclusions. Giving naloxone to heroin overdoses in the field and then allowing the patients to sign out AMA resulted in no death in the one-year period studied. This study did not evaluate for return visits by paramedics nor whether patients were later taken to hospitals by private vehicles. (Author' s abstract)