Acute opioid intoxication and overdose are common causes of presentation to emergency departments. Although naloxone, a pure opioid antagonist, has been available for many years, there is still confusion over the appropriate dose and route of administration. This article looks at the reasons for this uncertainty and undertakes a literature review from which a treatment algorithm is presented.
This study aims to explore the distribution of naloxone among heroin users, and whether or not drug users are willing to administer the medication to others. 329 people were recruited to the study, most of whom had used heroin and nearly two thirds of whom reported that they had injected drugs. 64.6% reported having witnessed a drug overdose in the past, and over half of these had experienced an accidental drug overdose. The majority of individuals reported that they would be willing to administer a medication to a peer in the event of an overdose, regardless of their knowledge of first aid etc.
This research paper from Australia aims to determine the effectiveness of intranasal naloxone compared with intramuscular naloxone in the treatment of opiate overdoses and the associated respiratory depression. The authors conclude that, in prehospital settings at least – the intranasal delivery of naxolone may be preferable as it could reduce the risk of needle-stick injuries and exposure to blood-borne infections. It is also relatively safe to make more widely available – for example, to increase access to this life-saving treatment in the community.
This study aimed to prospectively test the effectiveness of intranasal naloxone administration by paramedics in the USA. A total of 30 patients received naloxone during the study period – 11 of whom responded to naloxone. The authors conclude that intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses, and use of this route – rather than intravenous naloxone - may be preferential as associated risks are minimal.
Doctors routinely give naloxone during emergency resuscitation after opiate overdose. The distribution of naloxone to opiate addicts has recently been addressed, and a survey of drug users shows extensive support for the provision of supplies to take away. We present the preliminary results of two pilot schemes to provide take home naloxone to opiate users.
This paper – in Harm Reduction International’s official journal – is a detailed legal analysis of naloxone provision in the United States. The authors found that the prescription of naloxone is fully compliant with state and federal laws regulating drug prescribing. They conclude that the risks of malpractice liability are consistent with those generally associated with providing healthcare, and offer simple guidelines to minimise these risks further.
Overdose deaths are a major contributor to excess mortality among heroin users. It has been proposed that opioid overdose morbidity and mortality could be reduced substantially by distributing the opioid antagonist naloxone to heroin users. The ethical issues raised by this proposal are evaluated from a utilitarian perspective. The potential advantages of naloxone distribution include the increased chance of comatose opioid users being quickly resuscitated by others present at the time of an overdose, naloxone's safety and its lack of abuse potential.