Impact of prehospital olanzapine for methamphetamine intoxication on patient and system-level outcomes: a population-based retrospective cohort study.
BMJ Open · 2026-10-08 · Observational study
Abstract
INTRODUCTION: Acute methamphetamine intoxication is a common presentation in emergency departments (EDs). Empowering paramedics to treat methamphetamine intoxication in the prehospital setting could help to improve patient and system outcomes. This study evaluated the impact of a 2018 policy allowing paramedics to administer olanzapine for methamphetamine intoxication in the prehospital setting on patient and system outcomes. METHODS: Retrospective pre-post analysis of population-based health administrative data and qualitative paramedic reports. Individuals with a methamphetamine-related health system contact between 2016–2020 in Winnipeg, Canada, who were eligible for pre-hospital olanzapine were included. The exposure was the administration of olanzapine in the pre-hospital setting by paramedics. Individuals who received prehospital olanzapine were compared with those who did not, prior to (2016–2018) and after (2018–2020) the policy change. Primary outcomes included physical or chemical restraint prior to ED, transport to ED and leaving from the ED prior to being seen or against medical advice. Outcomes were modelled using logistic (binary outcomes) and Cox proportional hazard (temporal outcomes) models adjusted for covariates using inverse probability of treatment weighting. RESULTS: The cohort included 1041 individuals, of which 222 received the intervention. Among individuals receiving olanzapine, the median age was 31 years, 58.1% were male, 56.8% were in the lowest income quintile and a high prevalence of mental health disorders and legal system involvement were observed. After adjusting for covariates, individuals receiving olanzapine in the prehospital setting were more likely to be transported to ED by paramedics (adjusted OR (aOR): 11.83, 95% CI 3.19 to 43.80) and less likely to leave the ED without being seen by a doctor (aOR: 0.56, 95% CI 0.32 to 0.97) compared with individuals who did not. CONCLUSIONS: Prehospital administration of olanzapine among individuals experiencing methamphetamine intoxication was associated with a higher likelihood of transport to the ED and being seen by a physician.
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Tags
Antipsychotics · Poisoning & substance use · Sedatives & anxiolytics · Stimulants
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