{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:01:29Z","timestamp":1768568489698,"version":"3.49.0"},"posted":{"date-parts":[[2024,8,28]]},"group-title":"Addiction Medicine","reference-count":75,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T00:00:00Z","timestamp":1724803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,11,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In consideration of rising opioid-stimulant deaths in the United States, this study explored rates of naloxone administration and survival in suspected opioid overdoses with, versus without, stimulants co-involved.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study analyzed 26,635 suspected opioid-involved overdoses recorded by law enforcement\/first-responders in the Pennsylvania Overdose Information Network in 63 Pennsylvania counties, January 2018-July 2024. All measures, including suspected drug involvement, were based on first-responder assessment\/report. Relative frequencies and chi-square tests were first used to compare suspected opioid overdoses with, versus without, stimulants (cocaine or methamphetamine) co-involved. Next, mediation analyses tested naloxone administration as a mediator in the association between stimulant co-involvement (in opioid overdoses) and survival.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Naloxone was reportedly administered in 72.2% of the suspected opioid-no-cocaine overdoses, compared to 55.1% of the opioid-cocaine-involved overdoses, and 72.1% of the opioid-no-methamphetamine overdoses vs. 52.4% of the opioid-methamphetamine-involved overdoses. With respect to survival rates, 18.0% of the suspected opioid-no-cocaine overdoses ended in death, compared to 41.3% of the opioid-cocaine overdoses; 18.1% of the opioid-no-methamphetamine overdoses ended in death, versus 42.9% of the opioid-methamphetamine overdoses. In mediation analyses (adjusted for demographics, county, year, and other drug co-involvement), naloxone administration mediated 38.7% (95% Confidence Interval [CI], 31.3%-46.0%) of the association between suspected cocaine co-involvement and survival and 39.2% (95% CI, 31.3%-47.1%) of the association between suspected methamphetamine co-involvement and survival.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Among suspected opioid overdoses recorded in the Pennsylvania Overdose Information Network, stimulant co-involvement was associated with lower naloxone administration and higher fatality, with naloxone partially mediating the association between stimulant co-involvement and death.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.08.27.24312661","type":"posted-content","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T14:15:20Z","timestamp":1724854520000},"source":"Crossref","is-referenced-by-count":0,"title":["Naloxone Administration and Survival in Overdoses Involving Opioids and Stimulants: An Analysis of Law Enforcement Data from 63 Pennsylvania Counties"],"prefix":"10.64898","author":[{"given":"Manuel","family":"Cano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abenaa","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sydney M.","family":"Silverstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raminta","family":"Daniulaityte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"LoVecchio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2024112605150432000_2024.08.27.24312661v2.1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.918197"},{"key":"2024112605150432000_2024.08.27.24312661v2.2","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-5333150\/v1"},{"key":"2024112605150432000_2024.08.27.24312661v2.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102718"},{"key":"2024112605150432000_2024.08.27.24312661v2.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa2212412"},{"key":"2024112605150432000_2024.08.27.24312661v2.5","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"2024112605150432000_2024.08.27.24312661v2.6","doi-asserted-by":"publisher","DOI":"10.1080\/10439463.2021.2020783"},{"key":"2024112605150432000_2024.08.27.24312661v2.7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0263893"},{"key":"2024112605150432000_2024.08.27.24312661v2.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-022-06125-5"},{"key":"2024112605150432000_2024.08.27.24312661v2.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108148"},{"key":"2024112605150432000_2024.08.27.24312661v2.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-022-02255-5"},{"key":"2024112605150432000_2024.08.27.24312661v2.11","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.202000196"},{"key":"2024112605150432000_2024.08.27.24312661v2.12","unstructured":"Center for Rural Pennsylvania. 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