b'PACEP EMS UpdateNalmefene in the Prehospital Setting:Evidence, Safety, and Policy ConsiderationsAvram Flamm, DO, FACEP|Stephanie Costa, MDuse without large, contemporary clinical trials inthe first-line prehospital treatment for suspected real-world overdose populations. The approvalopioid overdose. Nalmefene may merit further pathway relied largely on pharmacokineticinvestigation, but it has not demonstrated equivalence data rather than comparativesuperiorityor even clear non-inferiorityunder effectiveness studies against Naloxone in opioidreal-world conditions.overdose scenarios. In contrast, NaloxonesHouse Bill 2182 is well intentioned. However, it effectiveness is supported by decades of fieldrisks introducing into routine prehospital care a experience and clinical data. medication that does not yet offer proven benefit Ethicists and public health scholars have echoedover the established standard and may harm caution. Navin, Fink, and Rieder (2025) arguepatients. Overdose management should rely on that stronger isnt always better, describingtherapies that are known to be effective, cost-Nalmefene as an example of a quick-fix publicefficient, and safe.health intervention that has not demonstrated superior clinical outcomes. Public health officials in multiple jurisdictions have similarly expressedPACEP EMS members are encouraged to:hesitation in endorsing Nalmefene for widespread EMS or community use, citing insufficientReview the ACMT/AACT joint position statement and related literature.comparative data (EMS1, 2025). Advocate for policy decisions that prioritize high-quality evidence, Regulatory scrutiny has also emerged. The Newfiscal responsibility, and patient safety.York Attorney General recently intervened to stopUntil stronger comparative data are available, Pennsylvania should misleading marketing claims related to opioidcontinue using NALOXONE as the medication of choice for prehospital overdose reversal products, underscoring theopioid overdose care. Pennsylvania should not pass bills approving importance of ensuring that public health policyprehospital use of a drug that could potentially harm patients. is guided by evidence rather than promotional messaging (Office of the NY Attorney General, 2025).Cost considerations further complicate theReferences1.Stolbach AI, Mazer-Amirshahi ME, Nelson LS, Cole JB. American College of Medical Toxicology equation. Nalmefene is significantly more expensiveand the American Academy of Clinical Toxicology position statement: nalmefene should than Naloxone. A statewide addition to prehospitalnot replace naloxone as the primary opioid antidote at this time. Clin Toxicol (Phila). formularies would increase costs without2023;61(11):952-955. 2. Navin MC, Fink LR, Rieder TN. Stronger isnt always better: Nalmefene in community evidence of reducing mortality, reduced dosingoverdose response and the false promise of quick-fix public health solutions. Int J Drug Policy. requirements, or better patient-centered outcomes. 2025;124:104945.3.Office of the New York State Attorney General. Attorney General James stops misleading As emergency physicians, EMS medical directors,marketing of unauthorized opioid overdose products. 2025. (https://ag.ny.gov/press-and frontline clinicians, our responsibility is torelease/2025/attorney-general-james-stops-misleading-marketing-unauthorized-opioid-advocate for interventions that are evidence- overdose)4. EMS1. Mass. public health officials hesitate to endorse nalmefene. 2025. (https://www.ems1. based, operationally sound, and safe acrosscom/public-health/mass-public-health-officials-hesitate-to-endorse-nalmefene)the entire EMSED continuum. At present, the literature supports maintaining NALOXONE as Winter 2026 27'