Naloxone administration and toxicity signs and symptoms: An observational study using Canadian death investigation data

A toxic drug supply is responsible for a high number of deaths in Canada. Naloxone is a medication that can temporarily reverse opioid toxicity but cannot act on other drug classes. Take-home naloxone is a key public health response to the overdose crisis where people who may witness an overdose are educated on naloxone administration and overdose response. This study aims to investigate signs and substances associated with naloxone administration stratified by opioid contribution to death and substances detected where naloxone was administered but opioids did not contribute to death. This observational study of Canadian coroner and medical examiner files from 2016 to 2017 uses descriptive and chi square analyses to determine what signs were associated with having been administered naloxone among people for whom opioids contributed to death and what substances were associated with naloxone administration among people for whom no opioids were detected or contributed to the death. The study included 1,521 people who died of acute drug toxicity. Naloxone was administered to 45% of those who died and was administered in higher proportions when opioids contributed to death (50%) compared to when opioids did not (35%). Among people for whom opioids contributed to death, having been administered naloxone was associated with expected opioid toxicity signs of snoring/gurgling, altered consciousness, appearing asleep, and being cold. Among people for whom opioids did not contribute to death, detection of opioids or stimulants were significantly associated with naloxone administration. Further investigation into the barriers to naloxone administration should be conducted in order to improve drug toxicity response education.