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    ​EMS Naloxone Leave-Behind​

    ​What is EMS Naloxone

    Naloxone leave-behind is a collaboration between public health and public safety that allows EMS clinicians to leave naloxone on-scene with patients and their support system.

    Research shows overdose survivors face a significantly increased risk of fatally overdosing in the future. EMS personnel can help reduce the risk of fatal overdose by giving naloxone kits directly to at-risk patients and their family, friends, and roommates.


    Why do Naloxone​ Leave-Behind?

    Naloxone Leave-Behind programs improve linkages to care in the community, which can reduce future overdoses and the strain on the EMS workforce.

    Naloxone is provided at no cost to EMS companies by the state of Maryland. While naloxone is not the sole answer to the overdose crisis, it can help patients live another day, improve community health, and prevent overburdening healthcare systems.​

    Naloxone leave-behind allows EMS p​rofessionals to directly give naloxone to exactly the people who need it the most. By providing these kits, EMS can save lives beyond the patient care given in the moment of an overdose.

    Benefits of Lea​​​ve-Behind


    Leave-behind allows clinicians to provide life-saving resources whether a patient accepts transport or not. In the long term, connecting patients to resources can make your job as an EMS clinician easier.

    First responders are uniquely positioned to interrupt the cycle of nonfatal-to-fatal opioid overdose by increasing distribution of overdose prevention resources to patients in real time.

    Leave-behind kits can also connect patients to 150 organizations​ that can dispense naloxone refills in every Maryland county.

    Leave-Behind in Maryland​


    Maryland’s leave-behind program, active since 2018, is here to stay. The program is opt-in by county.

    Between 2018 and 2021, thirteen jurisdictions operating EMS leave-behind programs successfully distributed 7,844 doses of naloxone to approximately 2,899 Marylanders.*

    Although data is still developing on recently implemented programs in Maryland, leave-behind programs have proven successful across multiple states.

    *Data as of 2/8/2022 as reported to the Maryland Department of Health Center f​​​or Harm Reduction Services through the Overdose Response Program Training Report Form.

    Learn More​​

    Best Practices in EM​​​S Naloxone Leave-Behind

    Howard County, Maryland EMS Leave-Be​​hind Study

    This study highlights the importance of engaging an individual’s family and social network when offering connections to treatment and recovery resources. NLB initiatives can potentially augment existing community-based naloxone training structures, thus widening the scope of the life-saving drug and reaching those most at risk of dying from an opioid overdose.

    Scharf, B. M., Sabat, D. J., Brothers, J. M., Margolis, A. M., & Levy, M. J. (2021). Best Practices for a Novel EMS-Based Naloxone Leave behind Program. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 25(3), 418–426. https://doi.org/10.1080/10903127.2020.1771490

    Engaging Emer​​​gency Medical Services in Naloxone Distribution

    The Engaging Emergency Medical Services in Naloxone Distribution brief report provides an overview of the naloxone leave-behind program and examples of the program in action in three states. View the webinar or download the brief.

    Vermont EMS​​​ Leave-Behind Study

    To supplement the state's naloxone distribution efforts, Vermont initiated an EMS protocol allowing all levels of providers to provide naloxone leave-behind kits to patients and/or their family or friends when a patient is identified as high-risk for opiate overdose and is not transported to a hospital by the responding EMS agency.

    Bissonette, Samantha J., "Preliminary Analysis of Vermont's EMS Naloxone Leave-Behind Program" (2021). Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects. 17. https://scholarworks.uvm.edu/m4sp/17

    Contra Costa County, Californ​​ia EMS Leave-Behind Innovation

    When an emergency physician in Contra Costa County, California, noticed opioid overdoses increasing to epidemic proportions and EMS providers often reviving the same patient repeatedly, he set out to break down silos across agencies to improve the local response. The result? The Four Pillars of Innovation: a leave-behind public naloxone distribution program; a warm handoff/data sharing program with the county public health department; an overdose receiving center; and an EMS-initiated buprenorphine project. Read the article.

    Mary Hedges, M. (2021, April 1). Four Pillars of Innovation: How EMS in Contra Costa County Connected Resources to Improve Opioid Epidemic Response. Catching Up with COSSAP. Retrieved from https://www.cossapresources.org/Content/Documents/Articles/CHJ_Four_Pillars_of_Innovation_Article_April_2021.pdf

    Contact the Center ​for Harm Reduction Services

    Please reach out to us at mdh.naloxone@maryland.gov​ with any questions.​