Preventing Fentanyl-Related Overdose Deaths with Naloxone—A Medical Examiner Study

An epidemic of fentanyl overdose deaths has led to community naloxone use to save lives, and it has been suggested that businesses face legal liability for failing to provide naloxone. This study reviewed Maryland fentanyl-related overdose deaths in 2022. A death was considered preventable by widespread availability and use of naloxone in the following circumstances: a witnessed arrest, a person suffering an overdose found within 30 minutes of last being known alive, a person found unresponsive who showed potential to be resuscitated by emergency medical services, or the person being "found dead" in a public area such that a reasonable opportunity existed for someone else to find the decedent earlier and administer naloxone before death occurred. Of the 2047 overdose deaths in the study, 13.5% were deemed possibly preventable, and 2.7% were found such that a business could have possibly provided naloxone. The preventable overdoses were most commonly found by a "close contact" (family, friend, boy/girlfriend, and room/housemate) in a residence. A targeted effort to educate and supply naloxone to people who use drugs and their close contacts offers the best chance of reducing fentanyl overdose deaths. Mandating all businesses to carry naloxone is not supported by this study.