Introduction: Emergency medical services (EMS) response to nonfatal overdoses represents an opportunity to provide linkage to services. However, patients may decline follow-on transportation. This paper examined predictors associated with non-transport after nonfatal opioid overdoses.
Methods: We undertook a cross-sectional analysis of 2021-2022 data from the National EMS Information System. The outcome was a binary measure of declined transport. Predictors included age, gender, race/ethnicity, response time, EMS level of care, naloxone does, setting, urbanicity, region, time, and day.
Results: We identified 710 263 nonfatal opioid overdose events, of which 12.4% ended in non-transport. Men were more likely to decline transport (average marginal effect [AME] 0.020 [95% CI, 0.019-0.022]), and Black patients were less likely to decline (AME -0.022 [95% CI, -0.024 to -0.021]). Compared with events involving an EMS-administered limited first dose (<2 mg), non-transports were more likely in events without naloxone administration (AME 0.075 [95% CI, 0.073-0.078]), with administration only by laypersons (AME 0.101 [95% CI, 0.096-0.107]), and when EMS administered higher first doses (2-4 mg AME 0.039 [95% CI, 0.037-0.041]; 4 mg+ AME 0.053 [95% CI, 0.049-0.056]).
Conclusion: Efforts to improve post-overdose care should focus on groups who are more likely to decline transport and on appropriate naloxone dosing.
Keywords: emergency response; linkage to care; nonfatal overdose; opioid overdose.
© The Author(s) 2025. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.