title: Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport.
abstract: Naloxone frequently is used to treat suspected heroin and opioid overdoses in the out-of-hospital setting. The authors' emergency medical services system has operated a policy of allowing these patients, when successfully treated, to sign out against medical advice (AMA) in the field.
  
  
  OBJECTIVE
  To evaluate the safety of this AMA policy.
  
  
  METHODS
  This is a retrospective review of out-of-hospital and medical examiner (ME) databases over a five-year period. The authors reviewed all ME cases in which opioid overdoses were listed as contributing to the cause of death. These cases 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 ethnicity when available.
  
  
  RESULTS
  There were 998 out-of-hospital patients who received naloxone and refused further treatment and 601 ME cases of opioid overdose deaths. When compared by age, time, date, sex, location, and ethnicity, there were no cases in which a patient was treated by paramedics with naloxone within 12 hours of being found dead of an opioid overdose.
  
  
  CONCLUSIONS
  Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.
authors.affiliation: Department of Emergency Medicine, University of California-San Diego Medical Center, 200 West Arbor Drive, Mailcode #8676, San Diego, CA 92103, USA. gmvilke@ucsd.edu
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: Christian
authors.initials: C
authors.lastname: Sloane
authors.forename: Alan M
authors.initials: AM
authors.lastname: Smith
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062787:Drug Overdose / Q000401:mortality; D004632:Emergency Medical Services; D005260:Female; D006291:Health Policy; D003932:Heroin / Q000506:poisoning*; D006556:Heroin Dependence / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009294:Narcotics / Q000506:poisoning*; D010351:Patient Discharge; D016896:Treatment Outcome; D016312:Treatment Refusal
chemical_list: D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D003932:Heroin