UMEM Educational Pearls

Category: Toxicology

Title: Intranasal administration of naloxone for suspected opioid overdose

Keywords: intranasal naloxone, opioid overdose, reversal (PubMed Search)

Posted: 6/19/2019 by Hong Kim, MD
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Naloxone distribution programs have been expanding to promote the naloxone adminstration by laypersons, usually intranasal (IN) device, to victims of opioid overdose. A recent study analyzed the reports of prehospital naloxone administration reported to a regional poison center.

  • 1139 cases of prehospital naloxone administrations were identified between 2015 and 2017.
  • 98.2% had ventilatory depression
  • 97% were unresponsive
  • Law enforcement officers administered 91% of the naloxone, 97.9% via IN route


Opioid toxicity revesal:

  • Opioid-induced ventilatory or CNS depression was reversed in 79.2% after administering a mean naloxone dose of 3.12 mg. 
  • EMS administered additional naloxone (mean dose: 2.2 mg) to 291 due to lack of or partial reversal of opioid toxicity. 
  • 254 out of 291 (92.4%) regained normal/improved mental and ventilatory status.  
  • 95.9% of the overdose victims survived.


However, between 2015 and 2017, the reversal rate decreased (82.1% to 76.4%) while mean administered naloxone dose increased (2.12 mg to 3.63 mg). The cause of this trend is unknown but the dose of commercially available IN naloxone kit increased from 2 mg to 4 mg in 2016.


Bottom line:

  • IN naloxone administration is an effective intervention to reverse opioid toxicity.
  • However, larger naloxone doses were administered between 2015 and 2017 while the reversal rate decreased.
  • It is essential for bystander/witness of overdose to notify EMS as overdose victims may require additional naloxone administration/medical attention.



Mahonski SG et al. Prepacked naloxone administration for suspected opioid overdose in the era of illicitly manufactured fentanyl: a retrospective study of regional poison center data. Clin Toxicol 2019.