{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:10:09Z","timestamp":1780485009708,"version":"3.54.1"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Although US opioid overdose deaths have recently declined, mortality remains higher than before the COVID-19 pandemic, and the role of naloxone in opioid-associated out-of-hospital cardiac arrest (OA-OHCA) remains uncertain. The American Heart Association has identified a critical evidence gap regarding the role of naloxone in resuscitation care.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association between naloxone administered by emergency medical services (EMS) clinicians and outcomes in patients with suspected OA-OHCA.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study of adults (aged \u226518 years) with EMS-treated OHCA used data from the California Resuscitation Outcomes Consortium from January 1, 2021, to December 31, 2022. The primary cohort was patients with OA-OHCA, identified using the Naloxone Cardiac Arrest Decision Instrument (NACARDI) as age younger than 50 years and unwitnessed cardiac arrest. Additional analyses were conducted in patients with EMS-presumed drug-related OHCA and all patients with OHCA. Data were analyzed between November 2024 and July 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Naloxone administration during EMS resuscitation.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was survival to hospital discharge. Secondary outcomes were favorable neurologic outcome and return of spontaneous circulation (ROSC). Inverse probability weighted regression was used to estimate naloxone treatment effects as absolute risk differences (ARDs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 3811 patients meeting NACARDI criteria (median patient age, 37 years [IQR, 30-43 years]; 2792 [73.3%] male), 1251 (32.8%) received naloxone and 2560 (67.2%) did not. Survival to hospital discharge occurred in 101 patients (8.1%) who received naloxone vs 112 (4.4%) who did not. Favorable neurologic outcome occurred in 92 (7.4%) vs 84 (3.3%) and sustained ROSC in 177 (14.1%) vs 245 (9.6%), respectively. After adjustment for patient, OHCA incident, and agency-level factors, naloxone was associated with improved survival to hospital discharge (ARD, 2.75 percentage points [pp]; 95% CI, 1.25 to 4.26 pp), favorable neurologic outcome (ARD, 3.18 pp; 95% CI, 1.79 to 4.57 pp), and sustained ROSC (ARD, 3.27 pp; 95% CI, 1.11 to 5.43 pp). In sensitivity analyses of patients who received epinephrine, naloxone was not associated with improved survival to hospital discharge (adjusted ARD, 0.31 pp; 95% CI, \u22120.09 to 1.58 pp) or the other clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, among patients with suspected OA-OHCA, EMS-administered naloxone was associated with improved survival and neurologic status and sustained ROSC. These findings support the need for a randomized trial to assess the effects of naloxone in opioid-associated cardiac arrest.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.15539","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:30:18Z","timestamp":1780068618000},"page":"e2615539","source":"Crossref","is-referenced-by-count":1,"title":["Naloxone and Clinical Outcomes in Suspected Opioid-Associated Out-of-Hospital Cardiac Arrests"],"prefix":"10.1001","volume":"9","author":[{"given":"Ralph C.","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Toy","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California"},{"name":"The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California"},{"name":"Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos C.","family":"Montoy","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliana","family":"Tolles","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California"},{"name":"The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California"},{"name":"David Geffen School of Medicine at UCLA, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F.","family":"Ehlers","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"},{"name":"California Poison Control System, San Francisco Division, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Joelle","family":"Donofrio-Odmann","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego"},{"name":"Rady Children\u2019s Hospital, San Diego, California"},{"name":"Department of Emergency Medicine, University of California, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Menegazzi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Gausche-Hill","sequence":"additional","affiliation":[{"name":"The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California"},{"name":"David Geffen School of Medicine at UCLA, Los Angeles, California"},{"name":"Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, Riverside School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Dillon","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, Davis, Sacramento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CAL-ROC Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"VanBuren","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nichole","family":"Bosson","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin W","family":"Ballard","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia M","family":"Breyre","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senai","family":"Kidane","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zita","family":"Konik","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Luoto","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Mackey","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S","family":"Rose","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Schlesinger","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Schmalz","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sheperd","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranav","family":"Shetty","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Vaezazizi","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin","family":"Agarwal","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Johnson","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger J","family":"Lewis","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"McMullan","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Sanko","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish I","family":"Shah","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hernando","family":"Garzon","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Nishijima","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie Y","family":"Madhok","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary P","family":"Mercer","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J","family":"Coyne","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A","family":"Kahn","sequence":"additional","affiliation":[{"name":"for the CAL-ROC Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"issue":"7","key":"zoi260444r4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.22303","article-title":"Trends in opioid toxicity-related deaths in the US before and after the start of the COVID-19 pandemic, 2011-2021.","volume":"6","author":"Gomes","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi260444r5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.0217","article-title":"The burden of opioid-related mortality in the United States.","volume":"1","author":"Gomes","year":"2018","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi260444r6","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1056\/NEJMc2304991","article-title":"Fentanyl-associated overdose deaths outside the hospital.","volume":"389","author":"Jeffery","year":"2023","journal-title":"N Engl J Med"},{"issue":"6","key":"zoi260444r7","doi-asserted-by":"publisher","first-page":"202","DOI":"10.15585\/mmwr.mm7006a4","article-title":"Trends and geographic patterns in drug and synthetic opioid overdose deaths\u2014United States, 2013-2019.","volume":"70","author":"Mattson","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"50-51","key":"zoi260444r8","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.15585\/mmwr.mm6450a3","article-title":"Increases in drug and opioid overdose deaths\u2014United States, 2000-2014.","volume":"64","author":"Rudd","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"457","key":"zoi260444r9","first-page":"1","article-title":"Drug overdose deaths in the United States, 2001-2021.","author":"Spencer","year":"2022","journal-title":"NCHS Data Brief"},{"issue":"16","key":"zoi260444r11","doi-asserted-by":"publisher","first-page":"e836","DOI":"10.1161\/CIR.0000000000000958","article-title":"Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association.","volume":"143","author":"Dezfulian","year":"2021","journal-title":"Circulation"},{"issue":"5","key":"zoi260444r12","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1001\/jamapsychiatry.2020.4218","article-title":"Overdose-related cardiac arrests observed by emergency medical services during the US COVID-19 epidemic.","volume":"78","author":"Friedman","year":"2021","journal-title":"JAMA Psychiatry"},{"issue":"14","key":"zoi260444r13","doi-asserted-by":"publisher","first-page":"1398","DOI":"10.1001\/jama.2022.2847","article-title":"Trends in drug overdose deaths among US adolescents, January 2010 to June 2021.","volume":"327","author":"Friedman","year":"2022","journal-title":"JAMA"},{"key":"zoi260444r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110206","article-title":"Recognizing the fastest growing cause of out-of-hospital cardiac arrest.","volume":"198","author":"Orkin","year":"2024","journal-title":"Resuscitation"},{"key":"zoi260444r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110159","article-title":"Trends in presumed drug overdose out-of-hospital cardiac arrests in San Francisco, 2015-2023.","volume":"198","author":"Wang","year":"2024","journal-title":"Resuscitation"},{"key":"zoi260444r16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.resuscitation.2015.06.015","article-title":"Outcomes of patients resuscitated from cardiac arrest in the setting of drug overdose.","volume":"94","author":"Katz","year":"2015","journal-title":"Resuscitation"},{"key":"zoi260444r17","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.resuscitation.2015.11.010","article-title":"Regional incidence and outcome of out-of-hospital cardiac arrest associated with overdose.","volume":"99","author":"Salcido","year":"2016","journal-title":"Resuscitation"},{"issue":"4","key":"zoi260444r18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0176441","article-title":"Out-of-hospital cardiac arrest survival in drug-related versus cardiac causes in Ontario: a retrospective cohort study.","volume":"12","author":"Orkin","year":"2017","journal-title":"PLoS One"},{"issue":"3","key":"zoi260444r19","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.031245","article-title":"Cardiac arrest following drug overdose in the United States: an analysis of the Cardiac Arrest Registry to Enhance Survival.","volume":"13","author":"Shekhar","year":"2024","journal-title":"J Am Heart Assoc"},{"issue":"11","key":"zoi260444r20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.41921","article-title":"Presentation and outcomes of adults with overdose-related out-of-hospital cardiac arrest.","volume":"6","author":"Yogeswaran","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi260444r21","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1056\/NEJMra1202561","article-title":"Management of opioid analgesic overdose.","volume":"367","author":"Boyer","year":"2012","journal-title":"N Engl J Med"},{"issue":"16","key":"zoi260444r22","doi-asserted-by":"publisher","first-page":"e149","DOI":"10.1161\/CIR.0000000000001161","article-title":"2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.","volume":"148","author":"Lavonas","year":"2023","journal-title":"Circulation"},{"issue":"16_suppl_2","key":"zoi260444r23","doi-asserted-by":"publisher","first-page":"S578","DOI":"10.1161\/CIR.0000000000001380","article-title":"Part 10: Adult and pediatric special circumstances of resuscitation: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.","volume":"152","author":"Cao","year":"2025","journal-title":"Circulation"},{"issue":"5","key":"zoi260444r24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.14351","article-title":"Identification and treatment of opioid-associated out-of-hospital cardiac arrest in emergency medical service protocols.","volume":"5","author":"Dillon","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"8","key":"zoi260444r25","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.29154","article-title":"Naloxone and patient outcomes in out-of-hospital cardiac arrests in California.","volume":"7","author":"Dillon","year":"2024","journal-title":"JAMA Netw Open"},{"key":"zoi260444r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.resplu.2025.100906","article-title":"Opioid-associated cardiac arrest: a systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies.","volume":"22","author":"Grunau","year":"2025","journal-title":"Resusc Plus"},{"key":"zoi260444r27","doi-asserted-by":"publisher","first-page":"A429","DOI":"10.1161\/circ.148.suppl_1.429","article-title":"Abstract 429: The association between naloxone administration and outcomes for out-of-hospital cardiac arrest due to suspected overdose.","volume":"148","author":"Strong","year":"2023","journal-title":"Circulation"},{"key":"zoi260444r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110263","article-title":"The association of early naloxone use with outcomes in non-shockable out-of-hospital cardiac arrest.","volume":"201","author":"Strong","year":"2024","journal-title":"Resuscitation"},{"issue":"3","key":"zoi260444r29","doi-asserted-by":"publisher","first-page":"e249","DOI":"10.1016\/j.jemermed.2024.03.038","article-title":"Outcomes of out-of-hospital cardiac arrest patients who received naloxone in an emergency medical services system with a high prevalence of opioid overdose.","volume":"67","author":"Quinn","year":"2024","journal-title":"J Emerg Med"},{"key":"zoi260444r30","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1111\/acem.14718","article-title":"Does naloxone improve outcomes in cardiac arrests related to opiate overdose","volume":"30","author":"Love","year":"2023","journal-title":"Acad Emerg Med"},{"key":"zoi260444r31","doi-asserted-by":"publisher","DOI":"10.1016\/j.resplu.2025.100992","article-title":"The California Resuscitation Outcomes Consortium (CAL-ROC): a novel collaboration to facilitate the implementation of randomized clinical trials in the prehospital setting.","volume":"24","author":"Tolles","year":"2025","journal-title":"Resusc Plus"},{"issue":"9","key":"zoi260444r32","doi-asserted-by":"publisher","first-page":"e203","DOI":"10.1161\/CIR.0000000000001243","article-title":"Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template.","volume":"150","author":"Bray","year":"2024","journal-title":"Circulation"},{"issue":"4","key":"zoi260444r33","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"zoi260444r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110851","article-title":"Validation of the naloxone cardiac arrest decision instrument for identifying opioid-associated cardiac arrests.","volume":"217","author":"Dillon","year":"2025","journal-title":"Resuscitation"},{"key":"zoi260444r35","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.resuscitation.2020.12.009","article-title":"Naloxone Cardiac Arrest Decision Instruments (NACARDI) for targeted antidotal therapy in occult opioid overdose precipitated cardiac arrest.","volume":"159","author":"Rodriguez","year":"2021","journal-title":"Resuscitation"},{"key":"zoi260444r36","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110569","article-title":"Evaluating the accuracy of surrogate markers for identifying opioid-associated out-of-hospital cardiac arrests.","volume":"209","author":"Jasti","year":"2025","journal-title":"Resuscitation"},{"issue":"31","key":"zoi260444r37","doi-asserted-by":"publisher","first-page":"850","DOI":"10.15585\/mmwr.mm6731a2","article-title":"Naloxone administration frequency during emergency medical service events\u2014United States, 2012-2016.","volume":"67","author":"Cash","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"22","key":"zoi260444r38","doi-asserted-by":"publisher","first-page":"e783","DOI":"10.1161\/CIR.0000000000000562","article-title":"COSCA (Core Outcome Set for Cardiac Arrest) in adults: an advisory statement from the International Liaison Committee on Resuscitation.","volume":"137","author":"Haywood","year":"2018","journal-title":"Circulation"},{"key":"zoi260444r39","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.resuscitation.2019.08.036","article-title":"Long-term trends in the epidemiology of out-of-hospital cardiac arrest precipitated by suspected drug overdose.","volume":"144","author":"Alqahtani","year":"2019","journal-title":"Resuscitation"},{"key":"zoi260444r40","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.resuscitation.2018.12.020","article-title":"The incidence and outcomes of out-of-hospital cardiac arrest precipitated by drug overdose: a systematic review and meta-analysis.","volume":"134","author":"Alqahtani","year":"2019","journal-title":"Resuscitation"},{"issue":"28","key":"zoi260444r41","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.","volume":"34","author":"Austin","year":"2015","journal-title":"Stat Med"},{"issue":"11","key":"zoi260444r42","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.14977","article-title":"Effect of intranasal vs intramuscular naloxone on opioid overdose: a randomized clinical trial.","volume":"2","author":"Dietze","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"19","key":"zoi260444r43","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1161\/CIRCULATIONAHA.117.033067","article-title":"Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults.","volume":"137","author":"Hansen","year":"2018","journal-title":"Circulation"},{"key":"zoi260444r44","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.resuscitation.2018.02.006","article-title":"\u201cResuscitation time bias\u201d\u2014a unique challenge for observational cardiac arrest research.","volume":"125","author":"Andersen","year":"2018","journal-title":"Resuscitation"},{"key":"zoi260444r1","unstructured":"National Center for Health Statistics. Provisional drug overdose death counts. Centers for Disease Control and Prevention. Updated April 15, 2026. Accessed July 3, 2025. https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm"},{"key":"zoi260444r2","unstructured":"Centers for Disease Control and Prevention. US overdose deaths in 2021 increased half as much as in 2020\u2014but are still up 15%. May 11, 2022. Accessed July 21, 2022. https:\/\/www.cdc.gov\/nchs\/pressroom\/releases\/20220511.html?CDC_AAref_Val=https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2022\/202205.htm"},{"key":"zoi260444r3","unstructured":"National Institute on Drug Abuse. Drug overdose deaths: facts and figures. August 2024. Accessed April 4, 2023. https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"},{"key":"zoi260444r10","unstructured":"Saunders? H, Panchal? N, Rudowitz? R. Opioid overdose deaths: national trends and variation by demographics and states. February 24, 2026. KFF. Accessed April 22, 2026. https:\/\/www.kff.org\/mental-health\/opioid-overdose-deaths-national-trends-and-variation-by-demographics-and-states\/?utm_source=chatgpt.com"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2849629\/wang_2026_oi_260444_1779387078.97892.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:30:21Z","timestamp":1780068621000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2849629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":44,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.15539","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]}}}