Naloxone, a medicine that reverses the effects of opioid overdose, is being debated fiercely around the country right now. In most areas, the question is no longer whether to make naloxone more available to lay people and first responders, but what to do after a person overdoses and receives naloxone. One of these debates revolves around whether or not the patient should be transported to a hospital following an overdose and what to do when someone refuses. We hear things like:
- Drug users don’t care about their health because they refuse to go to the hospital after an overdose. They just want the first responders to leave so they can go out and use more drugs.
or
- Drug users can’t make decisions for themselves. They should be involuntarily committed to the hospital after an overdose for their own good.
Reactions like these minimize a couple of realities. First, there are a number of very rational reasons that any person, not just someone who has overdosed, would refuse transport and admission to a hospital after a medical incident. The first of these is lack of medical insurance. Many people who overdose do not have medical insurance and even for those who do, there is the question of deductibles, co-pays, limits on coverage, etc. Anyone who has ever been admitted to an emergency room and received a whopping bill afterwards knows the pain of realizing that a couple hours in an emergency room can cost thousands of dollars.
Second, many people who refuse transport to a hospital have had a history of mistreatment by paramedics or hospital staff. Stigma against drug users runs deep and the medical community is no exception. Although there are many medical professionals who are exemplary models of compassion and non-judgment, almost every drug user has at least one story of a personal encounter with a medical professional in which they were sneered at, denied treatment, degraded, etc. For this reason, many of them avoid hospitals except in dire emergencies.
You might ask – but isn’t an overdose a dire emergency? Well, without naloxone or some form of ventilation to help the patient breathe, yes. But once those interventions have been provided, most people are just fine after an overdose. Studies of people who received naloxone and were not admitted to a hospital have unilaterally shown very low rates of a second overdose or death over the next 24 hours. A recent study published by Prehospital Emergency Care reported deaths in 0.49 percent of patients within a 24 hour period following an overdose and subsequent refusal of hospital transport. This report corroborates other studies that showed similarly low rates of fatalities (as low as 0 out of hundreds of patients) after receiving naloxone even without followup hospital care.
The point is not to encourage patients to refuse hospital admission after receiving naloxone. Of course being admitted to a hospital is the safest option health-wise, for someone who has overdosed. The point is that patients who refuse hospital admission are often weighing the certainty of a substantial hospital bill (unless they have really good insurance, which most don’t) plus the possibility of humiliating treatment from medical staff (a fear often based on prior experience) against the chance of further complications from the overdose if they stay home – a chance that empirical studies have consistently shown to be less than 1 percent. They are in fact making a rational decision to stay home.
Need help with substance abuse or mentalhealth issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA NationalHelpline.