1st February 2024

An evaluation of naloxone transit for opioid overdose using drones: A case study using real-world coroner data

Royall, P. G., Courtnet, P., Goodair, C., et al. Addiction. 2023; Early View.

This study aimed to evaluate the feasibility of naloxone transit via drone to provide rapid access to naloxone at the point of care in the community. Using real-world data related to opioid overdoses in the Teesside area (2015-2019) the projected response times of ambulances were compared with drones. The impacts of traffic and weather conditions were considered. Fifty-eight cases were identified where a bystander, who could call an ambulance and administer naloxone, was likely present. 
The study found that a class C1 commercial-off-the-shelf drone carrying naloxone (intramuscular or intranasal) could have reached the overdose location in 78% of cases in 7 minutes (n = 45/58). In comparison, ambulances (even when considering best-case scenario traffic conditions) were able to reach only 14% of cases in 7 minutes (n = 8/58). The authors estimated that with recent advances in drone engineering allowing increased speeds and temperature-controlled cargo cradles, 98% of overdoses (n = 57/58) could have been reached in the 7-minute timeframe.
The authors conclude that their study provides proof-of-concept that in the Teesside area drones are more likely than ambulance to transport naloxone to opioid overdose sites in 7 minutes. 
Commentary:
Drones are increasingly being used in emergency medicine to deliver everything from medications and medical supplies to blood products and organs to remote and rural areas (Johnson et al., 2021). The delivery of automatic external defibrillators for the management of out-of-hospital cardiac arrests is also being studied (Johnson et al., 2021). It is heartening to see that this technology is also being considered to increase access to naloxone. It is a sad fact that, although we know that take-home naloxone saves lives, and it is readily available in a number of places, people continue to die at home from opioid overdoses. So, I am in favour of anything that might increase provision of naloxone to those who need it, when they need it.
There are a few barriers to using drones to deliver medication, and they are mostly weather-related. The authors identified 13 “no-go cases”, where drone flights were not possible either due to heavy rain, low temperatures below that permitted for naloxone storage, or high winds. However, they were confident that with newer drone technology with temperature-controlled cargo cradles some of these barriers could be removed. Another factor that would impact drone response times is the avoidance of no-fly zones (e.g. airports and prisons). Whilst this was not an issue with any of the identified cases in this study, it would need to be considered when calculating journey times in other locations. 
The main limitations of this study were that the authors had to make a number of assumptions in their modelling. For example, they assumed that permission would be granted for drone stations to be installed at identified locations, and that staff would be available immediately to drive ambulances and pilot drones. They also used wind data that was not specific to exact overdose locations, and the exact timings of all overdoses were not known. Despite these limitations, this technology holds real promise for increasing access to naloxone in emergency situations, particularly in semi-urban and rural areas. More prospective studies in real-world settings are now needed to evaluate whether or not drone delivery of naloxone is superior to ambulance response times. 
References:
Impact of using drones in emergency medicine: What does the future hold?
Johnson, A. M., Cunningham, C. J., Arnold, E., et al. Open Access Emergency Medicine. 2021;13. Read reference
Written by Tom Jones, Master of Advanced Nursing Practice

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